AAMCN 2025 EXAM QUESTIONS & ANSWERS
SOLVED 100% CORRECT!!
Key components of Managed Care Answer - Health education and preventive
medicine
Balance billing means charging or collecting from a Medicare beneficiary an
amount in excess of the Medicare reimbursement rate for Medicare-covered
services or supplies provided to a Medicare beneficiary, except when Answer -
Medicare is the beneficiary's secondary insurer
What organization is known as the forerunner of HMO's and is the largest
group model HMO today? Answer - Kaiser Permanenente Medical Care
Program
The HMO Act of 1973 Answer - Provided grants and loans to provide, start, or
expand HMO's
The health Insurance Portability and Accountability Act (HIPAA) gives providers
full discretion in determining what personal health information to include
when sending patients' medical records to other providers for treatment
purposes. Answer - true
, Which act removes insurance company barriers to emergency services, so you
can seek emergency care at a hospital outside of your health plan's network?
Answer - Affordable Care Act
Of the following, which is NOT a managed care product? Answer - Elective
Physician Organization (EPO)
Within a commercial HMO, there is no balance. billing. Answer - True
Medicare Advantage programs must be qualified by what organization?
Enrollment periods are also governed by this organization. Answer - Centers
for Medicare and Medicaid Services
There are two types of risk one can assume from Provider Service Networks
(PSN), business risk and Answer - Insurance Risk
Which of the following is true about PHO's Answer - Legal entity formed and
owned by one or more hospitals and physician groups to obtain payer contracts
and further mutual interests, hospitals are vulnerable, may be delegated UM<
CM< Credentialing, Quality Management
Whihc of the following is not part of TRICARE Answer - TRICARE Premiere
Which is true for fee for service? Answer - A patient sees a provider and the
provider bills the health plan for the service
Prepayment for services on a per member per month basis is called what?
Answer - Capitation
SOLVED 100% CORRECT!!
Key components of Managed Care Answer - Health education and preventive
medicine
Balance billing means charging or collecting from a Medicare beneficiary an
amount in excess of the Medicare reimbursement rate for Medicare-covered
services or supplies provided to a Medicare beneficiary, except when Answer -
Medicare is the beneficiary's secondary insurer
What organization is known as the forerunner of HMO's and is the largest
group model HMO today? Answer - Kaiser Permanenente Medical Care
Program
The HMO Act of 1973 Answer - Provided grants and loans to provide, start, or
expand HMO's
The health Insurance Portability and Accountability Act (HIPAA) gives providers
full discretion in determining what personal health information to include
when sending patients' medical records to other providers for treatment
purposes. Answer - true
, Which act removes insurance company barriers to emergency services, so you
can seek emergency care at a hospital outside of your health plan's network?
Answer - Affordable Care Act
Of the following, which is NOT a managed care product? Answer - Elective
Physician Organization (EPO)
Within a commercial HMO, there is no balance. billing. Answer - True
Medicare Advantage programs must be qualified by what organization?
Enrollment periods are also governed by this organization. Answer - Centers
for Medicare and Medicaid Services
There are two types of risk one can assume from Provider Service Networks
(PSN), business risk and Answer - Insurance Risk
Which of the following is true about PHO's Answer - Legal entity formed and
owned by one or more hospitals and physician groups to obtain payer contracts
and further mutual interests, hospitals are vulnerable, may be delegated UM<
CM< Credentialing, Quality Management
Whihc of the following is not part of TRICARE Answer - TRICARE Premiere
Which is true for fee for service? Answer - A patient sees a provider and the
provider bills the health plan for the service
Prepayment for services on a per member per month basis is called what?
Answer - Capitation
