AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 1:

  Two MCOs in a single service area divided purchasers into two groups and agreed to each market their products to only one purchaser group. This information indicates that these two MCOs violated antitrust requirements because they engaged in an activity key

  A. horizontal group boycott
  B. horizontal division of markets
  C. a tying arrangement
  D. price fixing
  B. horizontal division of markets

• Question 2:

  In response to the demand for a method of assessing outcomes, accrediting organizations and other government and commercial groups have developed quantitative measures of quality that consumers, purchasers, regulators, and others can use to compare health

  A. quality standards
  B. accreditation decisions
  C. standards of care
  D. performance measures
  D. performance measures

• Question 3:

  The data evaluation stage of utilization review (UR) includes both administrative reviews and medical reviews. One true statement about these types of reviews is that:

  A. An administrative review must be conducted by a health plan staff member who is a medical professional.
  B. The primary purpose of an administrative review is to evaluate the appropriateness of a proposed medical service.
  C. UR staff members typically conduct a medical review of a proposed medical service before they conduct an administrative review for that same service.
  D. One purpose of a medical review is to evaluate the medical necessity of a proposed medical service.
  D. One purpose of a medical review is to evaluate the medical necessity of a proposed medical service.

• Question 4:

  During the risk assessment process for a traditional indemnity group insurance health plan, group underwriters consider such characteristics as a group's geographic location, the size and gender mix of the group, and the level of participation in the grou

  A. Healthcare costs are typically higher in rural areas than in large urban areas.
  B. The morbidity rate for males is higher than the morbidity rate for females.
  C. The larger the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.
  D. All of the above
  C. The larger the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.

• Question 5:

  The following sentence contains an incomplete statement with two missing words. Select the answer choice that contains the words that correctly fill the two blanks, respectively. The philosophy of consumer choice involves having consumers play a(n) ______

  A. Decreased ... Increased
  B. Increased ... Decreased
  C. Increased ... Increased
  D. Decreased ... Decreased
  C. Increased ... Increased

• Question 6:

  One distinguishing characteristic of a health maintenance organization (HMO) is that, typically, an HMO

  A. arranges for the delivery of medical care and provides, or shares in providing, the financing of that care
  B. must be organized on a not-for-profit basis
  C. may be organized as a corporation, a partnership, or any other legal entity
  D. must be federally qualified in order to conduct business in any state
  A. arranges for the delivery of medical care and provides, or shares in providing, the financing of that care

• Question 7:

  In order to generate exchanges with consumers, healthcare plan marketers use the four elements of the marketing mix: product, price, place (distribution), and

  A. segmentation
  B. publicity
  C. promotion
  D. plan design
  C. promotion

• Question 8:

  When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previous

  A. Castle is responsible for paying for all incurred covered benefits
  B. Knoll is solely responsible for guaranteeing claim payments
  C. Knoll makes no premium payments to Castle
  D. Castle has no responsibilities for administering the health plan
  A. Castle is responsible for paying for all incurred covered benefits

• Question 9:

  Which out of the three is accomplished through precertification?

  A. Concurrent review
  B. Retrospective review
  C. Prospective review
  C. Prospective review

• Question 10:

  The following statements are about the make-up and function of an HMO's board of directors. Select the answer choice that contains the correct statement.

  A. The make-up of an HMO's board of directors is prescribed by state regulations and does not vary according to whether the plan is a for-profit or not-for-profit plan.
  B. The board of directors of a not-for-profit HMO is exempt from liability for its actions.
  C. An HMO's board of directors is not responsible for supervising the performance of its officers and outside advisors.
  D. A primary function of the board of directors is to approve and evaluate the organization's operational policies and procedures.
  D. A primary function of the board of directors is to approve and evaluate the organization's operational policies and procedures.