AHIP - FINAL EXAM QUESTIONS AND
ANSWERS
1. "self-funded" - ANSWER-self insurance
2. 21st Century Cures Act - ANSWER--offers huge investment to national institute of
health for precision medicine and biomedical studies, initiatives to conquer most
cancers
3. 4 maximum not unusual functions preformed through fitness plan scientific departments -
ANSWER-1) medical exceptional
2) usage control
three) populace health management
4) pharmacy advantage
4. ACA - ANSWER-Affordable Care Act
*requirement to permit coverage for dependent youngsters below a figure's policy
until 26
...............
5. Account managers - ANSWER-upkeep and renewal of current debts
6. Accreditation - ANSWER-undergoes examination of running methods to decide in
the event that they meet targeted criteria and ensure that they meet unique stage
of satisfactory
7. actuarial dept - ANSWER-stats, math and economic theory
- financial safeguards
- examine organization's monetary effects
* layout plan benefits
* determine insurance premiums
* reveal organisation income
* advise corrective motion
* ensure funds are set aside to pay claims
* produces "ebook fee" for plan charges
- finalizing precise top class rates as soon as e-book fee is hooked up and health
plan can notify a selected employer group or man or woman insurance client of
his top class quantity
8. Affordable Care Act (ACA) - ANSWER-- institution underwriting, a few states permit
character scientific underwriting
- insurers are prohibited from discrimination because of pre-existing situations
9. annual growth in charges - ANSWER-- end result from client/authorities boundaries
positioned on controlled care
- different elements: higher issuer expenses, elevated use of tech in shipping of
care, health care fraud and different admin expenses
10.appeals - ANSWER-request that health plan rethink insurance decision
, - can be tied to UM dept
11.bending the heatlhcare cost curve - ANSWER-- making adjustments to healthcare
shipping system to attempt to decrease fee at which spending is going up
- need to grab line shifting up, reverse the trend and bend it downward
12.board - ANSWER-client of the fitness plan
13.agents - ANSWER-work w income dept of fitness plan
14.Care Management - ANSWER-move between case control and populace health
control
- treated through scientific specialists
- act as proactive/reactive resources to insured
- use health plan records to find contributors who've potential continual illnesses,
threat factors or styles of behavior
- concierge-type service
- fee due to the fact a) guarantees broader app of "proper/care/time/placing" and
b) private touch
15.Case Management - ANSWER-* medical certifications past RN license
* enables sufferers who've large clinical situations (acute/persistent illnesses) set
up and control hospital treatment
- make certain that those sufferers receive comprehensive hospital therapy
* goal--> proactive outreach, suitable observe-up care is brought
16.CDHC - ANSWER-patron-directed plan
(notes)
*pre-funded debts like HSA/HRA/FSA
17.young ones medical insurance program - ANSWER-notes
18.claims adjudication - ANSWER-evaluates claims dept
- want speed in system and price
- accuracy in bills
- late payments = fee
"smooth claims" - 30 days of receipt
"non-easy claims" - forty five days
19.claims dept - ANSWER-receives claims for payment and methods invoice
- process, configuration analysts, examiners, processors
bills: mailed or faxed to fitness plan
processing:
a) electronic billing (claims or IT)
b) automatic processing
c) paper claims
20.Clinical quality - ANSWER-* determines fitness plans medical guidelines,
determines what the right care is, determines timing of proper care
- flip records into quality hospital treatment
ANSWERS
1. "self-funded" - ANSWER-self insurance
2. 21st Century Cures Act - ANSWER--offers huge investment to national institute of
health for precision medicine and biomedical studies, initiatives to conquer most
cancers
3. 4 maximum not unusual functions preformed through fitness plan scientific departments -
ANSWER-1) medical exceptional
2) usage control
three) populace health management
4) pharmacy advantage
4. ACA - ANSWER-Affordable Care Act
*requirement to permit coverage for dependent youngsters below a figure's policy
until 26
...............
5. Account managers - ANSWER-upkeep and renewal of current debts
6. Accreditation - ANSWER-undergoes examination of running methods to decide in
the event that they meet targeted criteria and ensure that they meet unique stage
of satisfactory
7. actuarial dept - ANSWER-stats, math and economic theory
- financial safeguards
- examine organization's monetary effects
* layout plan benefits
* determine insurance premiums
* reveal organisation income
* advise corrective motion
* ensure funds are set aside to pay claims
* produces "ebook fee" for plan charges
- finalizing precise top class rates as soon as e-book fee is hooked up and health
plan can notify a selected employer group or man or woman insurance client of
his top class quantity
8. Affordable Care Act (ACA) - ANSWER-- institution underwriting, a few states permit
character scientific underwriting
- insurers are prohibited from discrimination because of pre-existing situations
9. annual growth in charges - ANSWER-- end result from client/authorities boundaries
positioned on controlled care
- different elements: higher issuer expenses, elevated use of tech in shipping of
care, health care fraud and different admin expenses
10.appeals - ANSWER-request that health plan rethink insurance decision
, - can be tied to UM dept
11.bending the heatlhcare cost curve - ANSWER-- making adjustments to healthcare
shipping system to attempt to decrease fee at which spending is going up
- need to grab line shifting up, reverse the trend and bend it downward
12.board - ANSWER-client of the fitness plan
13.agents - ANSWER-work w income dept of fitness plan
14.Care Management - ANSWER-move between case control and populace health
control
- treated through scientific specialists
- act as proactive/reactive resources to insured
- use health plan records to find contributors who've potential continual illnesses,
threat factors or styles of behavior
- concierge-type service
- fee due to the fact a) guarantees broader app of "proper/care/time/placing" and
b) private touch
15.Case Management - ANSWER-* medical certifications past RN license
* enables sufferers who've large clinical situations (acute/persistent illnesses) set
up and control hospital treatment
- make certain that those sufferers receive comprehensive hospital therapy
* goal--> proactive outreach, suitable observe-up care is brought
16.CDHC - ANSWER-patron-directed plan
(notes)
*pre-funded debts like HSA/HRA/FSA
17.young ones medical insurance program - ANSWER-notes
18.claims adjudication - ANSWER-evaluates claims dept
- want speed in system and price
- accuracy in bills
- late payments = fee
"smooth claims" - 30 days of receipt
"non-easy claims" - forty five days
19.claims dept - ANSWER-receives claims for payment and methods invoice
- process, configuration analysts, examiners, processors
bills: mailed or faxed to fitness plan
processing:
a) electronic billing (claims or IT)
b) automatic processing
c) paper claims
20.Clinical quality - ANSWER-* determines fitness plans medical guidelines,
determines what the right care is, determines timing of proper care
- flip records into quality hospital treatment
