QUESTION: 17

Amendments to the HMO act 1973 do not permit federally qualified HMO's to use

Retrospective experience rating
Adjusted community rating
Community rating by class
Community rating

Answer(s): A

QUESTION: 18

An exclusive provider organization (EPO) operates much like a PPO. However, one difference between an EPO and a PPO is that an EPO

Is regulated under federal HMO legislation
Generally provides no benefits for out-of-network care
Has no provider network of physicians
Is not subject to state insurance laws

Answer(s): B

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QUESTION: 19

An HMO that combines characteristics of two or more HMO models is sometimes referred to as a:

Network model HMO
Group model HMO
Staff model HMO
Mixed model HMO

Answer(s): D

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QUESTION: 20

Appropriateness of treatment provided is determined by developing criteria that if unmet will prompt further investigation of a claim which are also called:

Codes
Lists
Edits
Checks

Answer(s): C

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Free AHM-250 Exam Braindumps (page: 6)

QUESTION: 17

QUESTION: 18

QUESTION: 19

QUESTION: 20

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