AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 91:

  Which of the following features differentiates a 'Clinic without walls1 from a consolidated medical group?

  A. Unlike a consolidated medical group, physicians in a 'Clinic without walls' maintain their practices independently in multiple locations.

  B. Unlike a consolidated medical group, a 'Clinic without walls' performs or arranges for business operations for the member physicians.

  C. Both A and B

  Correct Answer: A

• Question 92:

  Which of the choices below contains the four tools used by marketers that make up the 'promotion mix'?

  A. Advertising, personal selling, sales promotion, and publicity.

  B. Advertising, price, sales promotion, and publicity.

  C. Admissions, personal selling, sales promotion, and publicity.

  D. Advertising, personal selling, sales promotion, and privacy.

  Correct Answer: A

• Question 93:

  George was covered by a united health care insurance policy. This policy says that Geroge has to pay $300 out of pocket for the medical expenses in that year before united health care will start to reimburse the medical expense incurred for George. What is the term used to call the out of pocket payment made by George.

  A. Co-payment

  B. Deductible

  C. Coinsurance

  D. None of the above

  Correct Answer: B

• Question 94:

  Ancillary services are

  A. General medical care that is provided directly to a patient without referral from another physician

  B. Also known as secondary care (Medical care that is delivered by specialist)

  C. Supplemental services needed as part of providing other care

  D. Outpatient services provided by a hospital or other qualified ambulatory care facility which require inpatient stay

  Correct Answer: C

• Question 95:

  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

  Correct Answer: D

• Question 96:

  The following statements describe common types of physician/hospital integrated models:

  The Iota Company, which is owned by a group of investors, is a for-profit legal entity that buys entire physician practices, not just the tangible assets of the practice

  A. Iota- physician hospital organization (PHO)Casa- physician practice management (PPM) company.

  B. Iota- physician hospital organization (PHO)Casa- medical foundation.

  C. Iota- physician practice management (PPM) Casa- physician hospital organization (PHO) company.

  D. Iota- medical foundation Casa- management services organization (MSO).

  Correct Answer: C

• Question 97:

  Graff Scott is a member of the ABC Health Plan. Whenever she needs non-emergency medical care, sees Dr. Michael Chan, an internist. Ms. Scott cannot self-refer to a specialist, so she saw Dr. Michael Chan when she experienced headaches. Dr. Michael Chan referred her to Dr. Bruce Lee, a neurologist, who had hospitalized at the Polo Hospital for tests. ABC has contracts with Dr. Michael Chan, Dr. Lee, and Polo to provide medical services to its members. The following statements are about Polo's organized system of healthcare. Select the answer choice containing the correct statement

  A. Within Polo's system, Ms. Scott received primary care from both Dr. Michael Chan and Dr. Lee

  B. Polo's system allows its members open access to all of Ultra's participating providers

  C. Polo's network of providers includes Dr. Michael Chan and Dr. Lee but not Polo Hospital

  D. Within Polo's system, Dr. Michael Chan serves as a coordinator of care or gatekeeper for the medical services that Ms. Scott receives

  Correct Answer: D

• Question 98:

  The Mirror Health Plan uses a form of computer/telephony integration (CTI) to manage telephone calls coming into its member services department. When a member calls the plan's central telephone number, a device answers the call with a recorded message and

  A. a member outreach program

  B. a complaint resolution procedure (CRP)

  C. an automatic call distributor (ACD)

  D. an interactive voice response (IVR) system

  Correct Answer: C

• Question 99:

  The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

  A. Under the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency

  B. The Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review

  C. According to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria

  D. The Quality Assessment and Improvement Model Act exempts closed plans from implementing a quality improvement program.

  Correct Answer: A

• Question 100:

  Wellborne HMO provides health-related information to its plan members through an Internet Web site. Laura Knight, a Wellborne plan member, visited Wellborne's Web site to gather uptodate information about the risks and benefits of various treatment option

  A. shared decision making

  B. self-care

  C. preventive care

  D. triage

  Correct Answer: A