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Free AHM-250 Exam Braindumps (page: 33)

Page 32 of 92
PDF with 367 Questions

Natalie Chan is a member of the Ultra Health Plan.
Whenever she needs non-emergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a specialist, so she saw Dr. Craig when she experienced headaches. Dr. Craig referred h

  1. Within Ultra's system, Ms. Chan received primary care from both Dr. Craig and Dr. Lee.
  2. Ultra's system allows its members open access to all of Ultra's participating providers.
  3. Within Ultra's system, Dr. Craig serves as a coordinator of care or gatekeeper for the medical services that Ms. Chan receives.
  4. Ultra's network of providers includes Dr. Craig and Dr. Lee but not Arrow Hospital.

Answer(s): C



One characteristic of disease management programs is that they typically

  1. focus on individual episodes of medical care rather than on the comprehensive care of the patient over time
  2. are used to coordinate the care of members with any type of disease, either chronic or nonchronic
  3. focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition
  4. use clinical practice processes to standardize the implementation of best practices among providers

Answer(s): D



One characteristic of the accreditation process for MCOs is that

  1. an accrediting agency typically conducts an on-site review of an MCO's operations, but it does not review an MCO's medical records or assess its member service systems
  2. each accrediting organization has its own standards of accreditation
  3. the accrediting process is mandatory for all MCOs
  4. government agencies conduct all accreditation activities for MCOs

Answer(s): B



One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

  1. A contract management system
  2. A credentialing system
  3. A legacy system
  4. An interoperable communication system

Answer(s): A






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