Exactprep AHM-250 Questions

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Question 28

Al Marak, a member of the Frazier Health Plan, has asked for a typical Level One appeal of a decision that Frazier made regarding Mr. Marak's coverage. One true statement about this Level One appeal is that

Options:

Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision

It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute

It is considered to be an informal appeal

It will be handled by an independent review organization (IRO)

Question 29

Following a report by the Institute of Medicine on the incidence and consequences of medical errors, a national task force recommended implementation of a nationwide mandatory system of collecting, analyzing, and reporting standardized information about m

Options:

random change

structural change

haphazard change

reactive change

Question 30

In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care. Such intervention can be based on the results of

Options:

Prospective review

Concurrent review

A, B, and C

A and B only

A and C only

B only

Question 31

From the following choices, choose the definition that best matches the term health risk assessment (HRA)

Options:

A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

A technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

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