AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 91:

  An exclusive provider organization (EPO) operates much like a PPO. However, one difference between an EPO and a PPO is that an EPO

  A. Is regulated under federal HMO legislation
  B. Generally provides no benefits for out-of-network care
  C. Has no provider network of physicians
  D. Is not subject to state insurance laws
  B. Generally provides no benefits for out-of-network care

• Question 92:

  The Venus Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot pay for the care by themselves or who receive services at reduced rates because they are covered under government sponsored

  A. anti selection
  B. cost shifting
  C. receivership
  D. underwriting
  B. cost shifting

• Question 93:

  In the CPT system, each service or procedure is identified by

  A. Three-digit with decimal point
  B. Three-digit
  C. Five-digit with decimal point
  D. Five-digit
  D. Five-digit

• Question 94:

  One feature of the Employee Retirement Income Security Act (ERISA) is that it:

  A. Requires self-funded employee benefit plans to pay premium taxes at the state level.
  B. Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.
  C. Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.
  D. Requires that state insurance laws apply to all employee benefit plans except insured plans.
  B. Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.

• Question 95:

  The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

  A. A decision as to which exclusions or limitations would apply for this product.
  B. A decision as to how to establish the network of participating providers for this product
  C. A determination of the level at which this product would cover out-of-network services.
  D. All of the above.
  D. All of the above.

• Question 96:

  Individuals can use HSAs to pay for the following types of health coverage:.

  A. Qualified disability insurance
  B. COBRA continuation coverage.
  C. Medigap coverage (for those over 65).
  D. All of the above.
  B. COBRA continuation coverage.

• Question 97:

  The Meadowcreek Group is an organization comprised of individual physicians and physicians in small group practices. Meadowcreek enters into contracts with health plans, and then Meadowcreek contracts separately with its physician members. In situations with

  A. a group practice without walls (GPWW)
  B. a messenger model
  C. an individual practice association (IPA)
  D. a Physician Practice Management (PPM) company
  C. an individual practice association (IPA)

• Question 98:

  The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. In early efforts to manage healthcare costs, traditional indemnity health insurers included in their health pla

  A. cost shifting
  B. deductibles
  C. underwriting
  D. copy
  B. deductibles

• Question 99:

  The Mabry County Hospital negotiated a contract with Wellfolk HMO. Mabry negotiated the inclusion of a provision in the contract whereby Mabry agreed to capitated compensation from Wellfolk up to a specified total cost of providing medical services for an

  A. quality assurance provision
  B. performance-based financial provision
  C. dual-choice provision
  D. stop-loss provision
  D. stop-loss provision

• Question 100:

  Combined system of preventive, diagnostic and therapeutic measures that focuses on management of specific chronic illness or medical conditions are:

  A. Utilization Review
  B. Case Management
  C. Demand Management
  D. Disease management
  B. Case Management