AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 101:

  The following statements apply to enrollment statistics for HSAs. Select the answer choice that contains the CORRECT statement.

  A. HSAs have helped expand health care coverage to consumers who were previously uninsured.

  B. The vast majority of enrollees in HSA health plans are wealthy.

  C. Most people receiving coverage through HSA health plans are individuals rather than families.

  D. HSAs appeal primarily to young consumers.

  Correct Answer: A

• Question 102:

  The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

  A. Both A and B

  B. A only

  C. B only

  D. Neither A nor B

  Correct Answer: A

• Question 103:

  Bill the member for the balance of the fee above the maximum allowable amount under the fee schedule reimbursement method

  A. UCR fee

  B. Capitation fee

  C. Balance bill

  D. Discounted fee-for-service

  Correct Answer: C

• Question 104:

  To determine fee reimbursements to be paid to physicians, the Triangle Health Plan assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier. Triangle and the providers negotiate the value of the

  A. diagnosis-related group (DRG) system

  B. relative value scale (RVS)

  C. partial capitation arrangement

  D. capped fee system

  Correct Answer: B

• Question 105:

  The act which requires each group health plan to allow employees and certain dependents to continue their group coverage for a stated period of time following a qualifying event that causes the loss of group health coverage is:

  A. ERISA

  B. COBRA

  Correct Answer: B

• Question 106:

  An HMO's quality assurance program must include

  A. A statement of the HMO's goals and objectives for evaluating and improving enrollees' health status

  B. Documentation of all quality assurance activities

  C. System for periodically reporting program results to the HMO's board of directors, its providers, and regulators

  D. All the above

  Correct Answer: D

• Question 107:

  The Robust Health Plan sometimes uses prospective experience rating to calculate the premiums for a group. Under prospective experience rating, Robust most likely will:

  A. At the end of a rating period, the financial gains and losses experienced by the group during that rating period and, if the group's experience during the period is better than expected, refund part of the group's premium in the form of an experience ratio

  B. Use Robust's average experience with all groups to calculate this particular group's premium.

  C. Use the group's past experience to estimate the group's expected experience for the next period.

  D. All of the above

  Correct Answer: C

• Question 108:

  The process that Mr. Sybex used to identify and classify the risk represented by the Koster Group so that Intuitive can charge premiums that are adequate to cover its expected costs is known as

  A. coinsurance

  B. plan funding

  C. underwriting

  D. pooling

  Correct Answer: C

• Question 109:

  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

  Correct Answer: C

• Question 110:

  The NAIC designed a small group model law to enable small groups to obtain accessible, yet affordable, group health benefits. Specifically, the model law limits the rate spread. According to this model law, if the lowest rate that an HMO charges a small g

  A. $80

  B. $120

  C. $160

  D. $240

  Correct Answer: C