Free AHM-510 – Governance and Regulation Practice Test Question

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  A foreign corporation
  

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  An alien corporation
  

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  A sister corporation
  

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  A domestic corporation
  

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  Transfers to Sienna all rights to terminate or suspend individual practitioners or providers in Hanford's provider network
  
  Both A and B
  

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  Describes the process by which Hanford evaluates Sienna's performance in credentialing providers
  
  
  A only
  

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  B only
  

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  Neither A nor B
  

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  Market skimming
  

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  Buying market share
  

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  Price skimming
  

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  Unitary pricing
  

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  Prohibits TPAs from performing insurance functions such as underwriting and claims processing
  

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  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
  

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  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
  

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  Requires TPAs to notify the state insurance department immediately following any material change in the TPA's ownership or control
  

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  Invitation to contract, and it discloses a policy provision known as an exception
  

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  Invitation to contract, and it discloses a policy provision known as a reduction
  

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  Invitation to inquire, and it discloses a policy provision known as an exception
  

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  Invitation to inquire, and it discloses a policy provision known as a reduction
  

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  Regulate the construction, renovation, and acquisition of healthcare facilities as well as the purchase of major medical equipment in a geographical area
  

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  Protect commerce from unlawful restraint of trade, price discrimination, price fixing, reduced competition, and monopolies
  

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  Determine benefit payments when a person is covered by more than one plan, such as two group health plans
  

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  License and regulate health plans that wish to establish and operate an HMO
  

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  Internal Revenue Service (IRS) and the Department of Justice (DOJ)
  

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  Office of Inspector General (OIG) and the Department of Defense (DOD)
  

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  Federal Trade Commission (FTC) and the Department of Labor (DOL)
  

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  Federal Trade Commission (FTC) and the Department of Justice (DOJ)
  

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  Parallel model
  

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  Shared model
  

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  Concurrent model
  

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  PACE model
  

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  All of these situations
  

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  Situations A and C only
  

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  Situation B only
  

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  Situation C only
  

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  For every plan in the FEHBP, OPM annually determines the lowest premium that is actuarially sound and then negotiates with each plan to establish that premium rate.
  

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  Once a health plan has submitted its rate proposals for a contract year to the OPM, it cannot adjust its premium rate for any reason.
  

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  To cover its administrative costs, OPM sets aside 1% of all FEHBP premiums.
  

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  Each spring, OPM sends all plan providers its call letter, a document that specifies the kinds of benefits that must be available to plan participants and cost goals and procedural changes that the plans need to adopt.