AHIP AHIP Certification AHM-250 Questions & Answers

• Question 1:

  Certificate of Authority (COA) is subject to:

  A. Contract between health plan and employer

  B. State laws require an HMO not to be organized as a corporation

  C. Compliance with CMS

  D. an HMO may have to be licensed as an HMO or insurance company in each state in which it conducts business

  Correct Answer: D

• Question 2:

  IROs stands for

  A. Internal Review Organizations

  B. International review Organizations

  C. Independent review organizations

  D. None of the above

  Correct Answer: C

• Question 3:

  The Mosaic health plan uses a typical electronic medical record (EMR) to document the medical care its members receive. One characteristic of Mosaic's EMR is that it:

  A. Does not provide any clinical decision support for Mosaic's providers.

  B. Is designed to supply information at the site of care.

  C. Contains a Mosaic member's clinical data only.

  D. Is organized by the type of treatment or by provider.

  Correct Answer: B

• Question 4:

  The Links Company, which offers its employees a self-funded health plan, signed a contract with a third party administrator (TPA) to administer the plan. The TPA handles the group's membership services and claims administration. The contract between Links

  A. a manual rating contract

  B. a funding vehicle contract

  C. an administrative services only (ASO) contract

  D. a pooling contract

  Correct Answer: C

• Question 5:

  To address the problems associated with multiple data management systems, the Kayak Health Plan has begun to use a data warehouse. One likely characteristic of Kayak's data warehouse is that:

  A. It requires Kayak's individual databases to store large amounts of data that are not needed for daily operations.

  B. It contains data from internal sources only.

  C. It stores historical data rather than current data.

  D. The data in the warehouse are linked by a common subject.

  Correct Answer: D

• Question 6:

  The existing committees at the Majestic Health Plan, a health plan that is subject to the requirements of HIPAA, include the Executive Committee and the Corporate Compliance Committee. The Executive Committee serves as a long-term advisory body on issues related to overall organizational policy. The Corporate Compliance Committee are convened to address specific management concerns. The following statement(s) can correctly be made about these committees:

  A. Majestic's Executive Committee is an example of a Specific committee.

  B. The Corporate Compliance Committee is an Example of an Adhoc company.

  C. A and B

  Correct Answer: B

• Question 7:

  The Oriole MCO uses a typical diagnosis-related groups (DRGs) payment method to reimburse the Isle Hospital for its treatment of Oriole members. Under the DRG payment method, whenever an Oriole member is hospitalized at Isle, Oriole pays Islet

  A. an amount based on the weighted value of each medical procedure or service that Isle provides, and the weighted value is determined by the appropriate current procedural terminology (CPT) code for the procedure or service

  B. a fixed rate based on average expected use of hospital resources in a given geographical area for that DRG

  C. a retrospective reimbursement based on the actual costs of the Oriole member's hospitalization

  D. a specific negotiated amount for each day the Oriole member is hospitalized

  Correct Answer: B

• Question 8:

  Which of the following job descriptions best match the job of a telephone triage staff member?

  A. Check patient vitals, write prescriptions, administer drugs.

  B. Greet patients at the door, collect insurance information, schedule appointments, collect payments.

  C. Determine urgency of the condition, notify emergency department, schedule appointments, authorize referrals, provide self-care information.

  D. None of the above.

  Correct Answer: C

• Question 9:

  The following statements are about accreditation in health plans. Select the answer choice that contains the correct statement.

  A. Accreditation is typically performed by a panel of physicians and administrators employed by the health plan under evaluation.

  B. All accrediting organizations use the same standards of accreditation.

  C. Results of accreditation evaluations are provided only to state regulatory agencies and are not made available to the general public.

  D. Accreditation demonstrates to an health plan's external customers that the plan meets established standards for quality care.

  Correct Answer: D

• Question 10:

  The Internal Revenue Service has ruled that an HDHP coupled with an HSA may cover certain types of preventive care without a deductible or with a lower amount than the annual deductible applicable to all other services. According to IRS guidance, which one

  A. Immunizations for children and adults

  B. Tests and diagnostic procedures ordered with routine examinations

  C. Smoking cessation programs

  D. Gastric bypass surgery for obesity

  Correct Answer: D