AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 101:

  The process of calculating the appropriate premium to charge purchasers, given the degree of risk represented by the individual or group, the expected costs to deliver medical services, and the expected marketability and competitiveness of the health plan

  A. financing
  B. rating
  C. underwriting
  D. budgeting
  B. rating

• Question 102:

  If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

  A. Transfer all of the HMO's business to other carriers.
  B. Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.
  C. Sell the HMO's assets in order to satisfy the HMO's obligations.
  D. Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.
  D. Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

• Question 103:

  High deductible health plans (HDHP) are characterized by all of the following features except

  A. A HDHPs have a higher deductible than other traditional insurance products such as HMOs and PPOs.
  B. HDHPs generally cost more than traditional heathcare coverage.
  C. Some HDHPs cover preventive care on a first-dollar coverage basis.
  D. All of the above
  A. A HDHPs have a higher deductible than other traditional insurance products such as HMOs and PPOs.

• Question 104:

  One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

  A. A contract management system
  B. A credentialing system
  C. A legacy system
  D. An interoperable communication system
  A. A contract management system

• Question 105:

  One characteristic of the accreditation process for MCOs is that

  A. an accrediting agency typically conducts an on-site review of an MCO's operations, but it does not review an MCO's medical records or assess its member service systems
  B. each accrediting organization has its own standards of accreditation
  C. the accrediting process is mandatory for all MCOs
  D. government agencies conduct all accreditation activities for MCOs
  B. each accrediting organization has its own standards of accreditation

• Question 106:

  The Courtland PPO maintains computerized records that include clinical, demographic, and administrative data about individual plan members. The data in these records is available to plan providers, ancillary service departments, pharmacies, and others inv

  A. a data warehouse
  B. a decision support system
  C. an outsourcing system
  D. an electronic medical record (EMR) system
  D. an electronic medical record (EMR) system

• Question 107:

  Abbreviation for JCAHO is

  A. Joint Coordination on Accreditation of Healthcare Organizations
  B. Joint Commission on Accreditation of Healthcare Organizations
  C. Joint Corporation on Accreditation of Healthcare Organizations
  D. Joint Connection on Accreditation of Healthcare Organizations
  B. Joint Commission on Accreditation of Healthcare Organizations

• Question 108:

  The Panacea Healthcare System is a single large medical practice based in Oakland, California. The physicians of Panacea operate through a single office located in the Beverly Hills region of Oakland and do have access to the same medical records. Panacea is owned by Queen's hospital and before Panacea acquired the practices of its participating physicians, these physicians were independent practitioners. Which of the following terms best describes Panacea?

  A. Physician Practice Management Compare
  B. Physician Hospital Organization
  C. Consolidated Medical Group
  D. None of the above
  C. Consolidated Medical Group

• Question 109:

  Medicare Part C can be delivered by the following Medicare Advantage plans:

  A. HCCP, HMO, PPO (local or regional), PFFS or MSA.
  B. CCPs, PFFS or MSA.
  C. HMO, HSA, PPO (local or regional), PFFS or MSA.
  D. HMO, PPO (local or regional), POS, or MSA.
  B. CCPs, PFFS or MSA.

• Question 110:

  Traditional Medicare includes two parts: Medicare Part A and Medicare Part B. With regard to the ways these parts differ from each other, it is correct to say that Medicare Part A

  A. provides benefits for physicians' professional services, whereas Medicare Part B provides basic hospitalization insurance
  B. is financed through premiums paid by covered persons and from the federal government's general tax revenues, whereas Medicare Part B is funded primarily through a payroll tax imposed on employers and workers
  C. provides 100% coverage for eligible medical expenses, whereas Medicare Part B includes annual deductible and coinsurance provisions
  D. is provided automatically to most eligible persons, whereas Medicare Part B is a voluntary program
  D. is provided automatically to most eligible persons, whereas Medicare Part B is a voluntary program