Online AHM-530 Questions Video

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Question 8

The Brice Health Plan submitted to Clarity Health Services a letter of intent indicating Brice’s desire to delegate its demand management function to Clarity. One true statement about this letter of intent is that it

Options:

creates a legally binding relationship between Brice and Clarity

most likely contains a confidentiality clause committing Brice and Clarity to maintain the confidentiality of documents reviewed and exchanged in the process

prohibits Clarity from performing similar delegation activities for other health plans

most likely contains a detailed description of the functions that Brice will delegate to Clarity

Question 9

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which increased the continuity and portability of health insurance coverage. One statement that can correctly be made about HIPAA is that it

Options:

Applies to group health insurance plans only

Limits the length of a health plan’s pre-existing condition exclusion period for a previously covered individual to a maximum of six months after enrollment.

Guarantees access to healthcare coverage for small businesses and previously covered individuals who meet specified eligibility requirements.

Guarantees renewability of group and individual health coverage, provided the insureds are still in good health

Question 10

Four types of APCs are ancillary APCs, medical APCs, significant procedure APCs, and surgical APCs. An example of a type of APC known as

Options:

An ancillary APC is a biopsy

Amedical APC is radiation therapy

Asignificant procedure APC is a computerized tomography (CT) scan

Asurgical APC is an emergency department visit for cardiovascular disease

Question 11

Some states have enacted any willing provider laws. From the perspective of the health plan industry, one drawback of any willing provider laws is that they often result in a reduction of a plan’s