NO.1 The Balanced Budget Act (BBA) of 1997 created the Medicare+Choice plan. One provision of the
BBA under Medicare+Choice is that the BBA
A. Requires health plans to qualify as either a competitive medical plan (CMP) or a federally qualified
HMO in order to participate in the Medicare program
B. Eliminates funding for demonstration projects such as the Medicare Enrollment Demonstration
Project
C. Narrows the geographic variations in payments to Medicare health plans by lowering the growth
rate of payments in high-payment counties and raising the rates in low-payment counties
D. Increases Graduate Medical Education (GME) payments to hospitals for the training and cost of
educating and training residents
Answer: C
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NO.2 Arthur Dace, a plan member of the Bloom Health Plan, tried repeatedly over an extended
period to schedule an appointment with Dr. Pyle, his primary care physician (PCP). Mr. Dace
informally surveyed other Bloom plan members and found that many people were experiencing
similar problems getting an appointment with this particular provider. Mr. Dace threatened to take
legal action against Bloom, alleging that the health plan had deliberately allowed a large number of
patients to select Dr. Pyle as their PCP, thus making it difficult for patients to make appointments
with Dr. Pyle.
Bloom recommended, and Mr. Dace agreed to use, an alternative dispute resolution (ADR) method
that is quicker and less expensive than litigation. Under this ADR method, both Bloom and Mr. Dace
presented their evidence to a panel of medical and legal experts, who issued a decision that Bloom's
utilization management practices in this case did not constitute a form of abuse. The panel's decision
is legally binding on both parties.
This information indicates that Bloom resolved its dispute with Mr. Dace by using an ADR method
known as:
A. Corporate risk management
B. An ombudsman program
C. An ethics committee
D. Arbitration
Answer: D
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NO.3 Health plans are allowed to appeal rules or regulations that affect them. Generally, the grounds
for such appeals are limited either to procedural grounds or jurisdictional grounds. The Kabyle Health
Plan appealed the following new regulations:
Appeal 1 - Kabyle objected to this regulation on the ground that this regulation is inconsistent with
the law.
Appeal 2 - Kabyle objected to this regulation because it believed that the subject matter was outside
the realm of issues that are legal for inclusion in the regulatory agency's regulations.
Appeal 3 - Kabyle objected to the process by which this regulation was adopted.
Of these appeals, the ones that Kabyle appealed on jurisdictional grounds were
A. Appeals 1, 2, and 3
B. Appeals 1 and 2 only
C. Appeals 1 and 3 only
D. Appeals 2 and 3 only
Answer: B
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NO.4 In the paragraph below, a statement contains two pairs of terms enclosed in parentheses.
Determine which term in each pair correctly completes the statement. Then select the answer choice
containing the two terms that you have chosen.
One type of acquisition is called a stock purchase. In a typical stock purchase, a company acquires
(51% / 100%) of the voting shares of another company's stock, thereby making the acquired company
a subsidiary. The (acquired / acquiring) company holds all of the assets and liabilities of the acquired
company.
A. 51% / acquired
B. 51% / acquiring
C. 100% / acquired
D. 100% / acquiring
Answer: C
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NO.5 Third party administrators (TPAs) provide various administrative services to health plans or
groups that provide health benefit plans to their employees or members. Many state laws that
regulate TPAs are based on the NAIC Third Party Administrator Model Statute. One provision of the
TPA Model Law is that it
A. Prohibits TPAs from performing insurance functions such as underwriting and claims processing
B. Prohibits TPAs from entering into an agreement under which the amount of the TPA's
compensation is based on the amount of premium or charges the TPA collects
C. Requires TPAs, upon the termination of a TPA agreement with a group, to immediately transfer all
its records relating to the group to the new administrator
D. Requires TPAs to notify the state insurance department immediately following any material
change in the TPA's ownership or control
Answer: D
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NO.6 After conducting a business portfolio analysis, the Acorn Health Plan decided to pursue a
harvest strategy with one of its strategic business units (SBUs)-Guest Behavioral Healthcare. By
following a harvest strategy with Guest, Acorn most likely is seeking to
A. Maximize Guest's short-term earnings and cash flow
B. Increase Guest's market share
C. Maintain Guest's market position
D. Sacrifice immediate earnings in order to fund Guest's growth
Answer: A
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NO.7 Regulators of health plans have set standards in a number of areas of plan operations.
Requirements with which health plans must comply typically include
A. providing enrollees and prospective enrollees with detailed information about various aspects of
health plan policies and operations
B. maintaining internal grievance and appeals processes to resolve enrollee complaints against the
organization
C. maintaining quality assurance programs that reflect the plan's activities in monitoring quality
D. all of the above
Answer: D
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NO.8 The Tidewater Life and Health Insurance Company is owned by its policy owners, who are
entitled to certain rights as owners of the company, and it issues both participating and
nonparticipating insurance policies. Tidewater is considering converting to the type of company that
is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated
under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and
Manitoba.
Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that
produce unrelated products and services. Tidewater remains an independent corporation and
continues to own Diversified and the subsidiaries. In order to create and maintain a common vision
and goals among the subsidiaries, the management of Diversified makes decisions about strategic
planning and budgeting for each of the businesses.
In order to become the type of company that is owned by people who purchase shares of the
company's stock, Tidewater must undergo a process known as
A. management buy-out
B. piercing the corporate veil
C. demutualization
D. mutualization
Answer: C
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もし君がAHIPのAHM-530に参加すれば、良い学習のツルを選ぶすべきです。AHIPのAHM-530認定試験はIT業界の中でとても重要な認証試験で、合格するために良い訓練方法で準備をしなければなりません。。
JapanCertは最高な品質で最速なスピードでAHIPのAHM-510認定試験の資料を更新するサイトでございます。もしかすると君はほかのサイトもAHIPのAHM-510認証試験に関する資料があるのを見つけた、比較したらJapanCertが提供したのがいちばん全面的で品質が最高なことがわかりました。
AHM-510認定試験の準備を完了したのですか。試験を目前に控え、自信満々と受験することができますか。もしまだ試験に合格する自信を持っていないなら、ここで最高の試験参考書を推奨します。ただ短時間の勉強で試験に合格できる最新のAHM-510問題集が登場しました。この素晴らしい問題集はJapanCertによって提供されます。
中国でこのような諺があります。天がその人に大任を降さんとする時、必ず先ず困窮の中におきてその心志を苦しめ、その筋骨を労し、その体膚を餓やし、その身を貧困へと貶めるのである。この話は現在でも真です。しかし、成功には方法がありますよ。正確な選択をしたら、そんなに苦労しなくても成功することもできます。JapanCertのAHIPのAHM-530試験トレーニング資料はIT職員を対象とした特別に作成されたものですから、IT職員としてのあなたが首尾よく試験に合格することを助けます。もしあなたは試験に準備するために知識を詰め込み勉強していれば、間違い方法を選びましたよ。こうやってすれば、時間とエネルギーを無駄にするだけでなく、失敗になるかもしれません。でも、今方法を変えるチャンスがあります。早くJapanCertのAHIPのAHM-530試験トレーニング資料を買いに行きましょう。その資料を手に入れたら、異なる人生を取ることができます。運命は自分の手にあることを忘れないでください。
AHIPのAHM-510認定試験を受験するあなたは、試験に合格する自信を持たないですか。それでも恐れることはありません。JapanCertはAHM-510認定試験に対する最高な問題集を提供してあげますから。JapanCertの AHM-510問題集は最新で最全面的な資料ですから、きっと試験に受かる勇気と自信を与えられます。これは多くの受験生に証明された事実です。
AHM-530認定試験の準備をするために一生懸命勉強して疲れを感じるときには、他の人が何をしているかを知っていますか。あなたと同じIT認定試験を受験する周りの人を見てください。あなたが試験のために不安と感じているとき、どうして他の人が自信満々で、のんびり見ているのでしょうか。あなたの能力は彼らうより弱いですか。もちろんそんなことはないです。では、なぜ他の人が簡単にAHM-530試験に合格することができるかを知りたいですか。それは彼らがJapanCert のAHM-530問題集を利用したからです。この問題集を勉強することだけで楽に試験に合格することができます。信じないのですか。不思議を思っていますか。では、急いで試してください。まず問題集のdemoを体験することができます。そうすれば、この問題集の品質を確認することができます。はやくJapanCertのサイトをクリックしてください。
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