AHM-530 Free Practice Test

- (Topic 2)
The BBA of 1997 specifies the ways in which a Medicare+Choice plan can establish and use provider networks. A Medicare+Choice plan that operates as a private fee for service (PFFS) plan is allowed to

1. A. limit the size of its network to the number of providers necessary to meet the needs of its enrollees
2. B. require providers to accept as payment in full an amount no greater than 115% of the Medicare payment rate
3. C. refuse payment to non-network providers who submit claims for Medicare-coveredexpenses
4. D. shift all risk for Medicare-covered services to network providers

Correct Answer: B

- (Topic 1)
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

1. A. Applies to group health insurance plans only
2. B. 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.
3. C. Guarantees access to healthcare coverage for small businesses and previously covered individuals who meet specified eligibility requirements.
4. D. Guarantees renewability of group and individual health coverage, provided the insureds are still in good health

Correct Answer: C

- (Topic 2)
With regard to the compensation of dental care providers in a managed dental care system, it is correct to state that, typically:

1. A. dental PPOs compensate dentists on a capitated basis
2. B. group model dental HMOs (DHMOs) compensate general dental practitioners on a salaried basis
3. C. independent practice association (IPA)-model dental HMOs (DHMOs) capitate general dental practitioners
4. D. staff model dental HMOs (DHMOs) compensate dentists on an FFS basis

Correct Answer: C

- (Topic 2)
The following statements are about Medicaid health plan entities. Select the answer choice containing the correct statement:

1. A. To keep Medicaid enrollment costs as low as possible, states typically prohibit the use of third-party entities known as enrollment brokers to handle the recruitment and enrollment of Medicaid recipients in health plan plans
2. B. Primary care case managers (PCCMs) are individuals who contract with a state's Medicaid agency to provide primary care services mainly to urban areas.
3. C. Typically, Medicaid beneficiaries must be given a choice between at least two health plan entities.
4. D. Medicaid health plan entities are responsible for providing primary coverage for all dually-eligible beneficiaries.

Correct Answer: C

- (Topic 2)
CMS Medicare+Choice regulations include a provision that allows health plans to deny benefits for any services the health plan objects to on moral or religious grounds. The provision that exempts health plans from providing such services is known as

1. A. a conscience protection exception
2. B. a hold harmless clause
3. C. a medical necessity determination
4. D. an intermediate sanction

Correct Answer: A