AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 111:

  The following statement(s) can correctly be made about electronic data interchange (EDI):

  A. EDI differs from eCommerce in that EDI involves back-and-forth exchanges of information concerning individual transactions, whereas eCommerce is the transfer of d

  B. Both A and B

  C. A only

  D. B only

  E. Neither A nor B

  Correct Answer: C

• Question 112:

  The following statements pertain to the federal requirements for minimum deductible and maximum out of pocket expeses for a high deductible health plan in the year 2006. Select the correct answer from the options given below.

  A. Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses- $ 2,100 for self only coverage

  B. Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses- $ 10.500 for family coverage

  C. Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses- $ 10,500 for self only coverage

  D. Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses- $ 5,250 for self only coverage

  Correct Answer: B

• Question 113:

  The NAIC adopted the HMO Model Act in order to provide a system of ongoing regulatory monitoring of HMOs. All of the following statements are correct about the HMO Model Act EXCEPT that it:

  A. Regulates HMO operations in two critical areas: financial responsibility and healthcare delivery.

  B. Requires each HMO to send state regulators an annual report describing the HMO's finances and operations.

  C. Focuses on three key aspects of healthcare delivery: network adequacy, quality assurance, and grievance procedures.

  D. Requires state insurance departments to conduct annual examinations of an HMO's operations, quality assurance programs, and provider networks.

  Correct Answer: D

• Question 114:

  The statements below describe technology used by two MCOs to respond to incoming telephone calls:

  The Morton MCO uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond to a menu of option

  A. Autumn's device is best described as an interactive voice response (IVR) system.

  B. Both Morton's system and Autumn's device are applications of computer/telephony integration (CTI).

  C. Morton's system is best described as an automatic call distributor (ACD).

  D. Morton's system can be correctly characterized as an expert system.

  Correct Answer: B

• Question 115:

  The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms you have selected.

  The Harbor Health Plan convened a litigation

  A. a standing / ongoing

  B. a standing / specific

  C. an ad hoc / ongoing

  D. an ad hoc / specific

  Correct Answer: D

• Question 116:

  Which of the following statements about Family and Medical Leave Act (FMLA) is WRONG?

  A. Employers need to maintain the coverage of group health insurance during this period

  B. Employees can take upto 12 weeks of unpaid leave in a 36 month period

  C. Protects people faced with birth/adoption or seriously ill family members

  D. Employers that have > 50 employees need to comply

  Correct Answer: B

• Question 117:

  Keith Murray is a 45 year old chartered accountant and is employed in Livingstone consultancy firm. He has been paying payroll taxes for the past 15 years. Which of the following statements is true regarding Medicare Part A entitlement?

  A. Keith shall be entitled to Part A benefits when he attains 65 years of age

  B. Keith's wife shall be entitled to Part A benefits when she attains 65 years of age

  C. Keith's wife shall be required to pay a monthly premium in order to receive Medicare Part A benefits

  D. Both a and b

  Correct Answer: D

• Question 118:

  Utilization management techniques that most HMOs use for hospital providers include:

  A. Discharge planning

  B. Case management

  C. Co-payment for office visits

  D. A and B

  Correct Answer: AB

• Question 119:

  The measures used to evaluate healthcare quality are generally divided into three categories: process, structure, and outcomes. An example of a process measure that can be used to evaluate a health plan's performance is the:

  A. Percentage of adult plan members who receive regular medical checkups.

  B. Number of plan members contracting an infection in the hospital.

  C. Percentage of board certified physicians within the health plan's network.

  D. Number of hospital admissions for plan members with certain medical conditions.

  Correct Answer: A

• Question 120:

  The Gable MCO sometimes experience-rates small groups by underwriting a number of small groups as if they constituted one large group and then evaluating the experience of the entire large group. This practice, which allows small groups to take advantage

  A. prospective experience rating

  B. pooling

  C. retrospective experience rating

  D. positioning

  Correct Answer: B