AHM-250 Reviews Questions

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Question 40

One HMO model can be described as an extension of a group model HMO because it contracts with multiple group practices, rather than with a single group practice. This HMO model is known as the

Options:

staff model HMO

IPA model HMO

direct contract model HMO

network model HMO

Question 41

Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

Options:

Acquisition of the Leopard Health Plan by the Hickory Health Plan.

Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

Consolidation of the Carver Health Plan and the Limestone Health Plan.

Question 42

Medicare is the federal government program established under Title XVIII of the Social Security Act of 1965 to provide hospital, medical and other covered benefits to elderly and disabled persons. Medicare is available for:

Options:

Persons age 63 or older.

Persons with qualifying disabilities (over the age of 63)

Persons with end-stage renal disease (ESRD)

Low income individuals

Question 43

Khalyn Drury's employer includes managed dental care in its employee benefits package. During open enrollment, Ms. Drury enrolled in the dental plan, which provides dental services to its members in exchange for a prepayment (the premium). Dental services