AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 131:

  The Citywide Health Group is a large provider-based health plan that includes physician groups, hospitals, and other facilities. In order to oversee and manage the operation of the organization, Citywide has established an enterprise scheduling system. The

  A. provide information to Citywide's management regarding provider licensure, certification, and malpractice history
  B. detect instances of overutilization, underutilization, or inappropriate utilization of medical resources
  C. allow Citywide's different components to function as a single organization in arranging access to facilities and resources
  D. facilitate the processing of requests for authorization of payment of benefits
  C. allow Citywide's different components to function as a single organization in arranging access to facilities and resources

• Question 132:

  During an open enrollment period in 1997, Amy Hadek enrolled through her employer for group health coverage with the Owl Health Plan, a federally qualified HMO. At the time of her enrollment, Ms. Hadek had three pre-existing medical conditions: angina, fo

  A. the angina, the high blood pressure, and the broken ankle
  B. the angina and the high blood pressure only
  C. none of these conditions
  D. the broken ankle only
  A. the angina, the high blood pressure, and the broken ankle

• Question 133:

  Managed behavioral health organizations (MBHOs) use several strategies to manage the delivery of behavioral healthcare services. The following statements are about these strategies. Select the answer choice that contains the correct statement.

  A. MBHOs generally provide benefits for mental health services but not for chemical dependency services.
  B. The level of care needed to treat behavioral disorders is the same for all patients and all disorders.
  C. By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.
  D. PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.
  C. By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.

• Question 134:

  The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide

  A. expert consultation to end-users for solving specialized and complex healthcare problems through the use of a knowledge-based computer system
  B. a comprehensive accreditation for PPOs
  C. measurements of plan performance and effectiveness that potential healthcare purchasers can use to compare quality offered by different healthcare plans
  D. a mathematical model that can predict future claim payments and premiums
  C. measurements of plan performance and effectiveness that potential healthcare purchasers can use to compare quality offered by different healthcare plans

• Question 135:

  A health savings account must be coupled with an HDHP that meets federal requirements for minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for inflation. For 2006, the annual deductible for self-only coverage must

  A. $525
  B. $1,050
  C. $2,100
  D. $5,250
  B. $1,050

• Question 136:

  From the following answer choices, choose the description of the ethical principle that best corresponds to the term Beneficence

  A. Health plans and their providers are obligated not to harm their members
  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group
  C. Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members
  D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives
  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

• Question 137:

  Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed- panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.

  A. All members of Holcomb HMO must select Dr. Phram as their primary care physician (PCP).
  B. Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.
  C. Dr. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO
  D. Holcomb HMO plan members may self-refer to Dr. Phram at full benefits without first obtaining a referral from their PCPs.
  A. All members of Holcomb HMO must select Dr. Phram as their primary care physician (PCP).

• Question 138:

  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
  C. A only

• Question 139:

  Who will be covered by TRICARE PRIME by applying for enrollment

  A. Active duty military personnel
  B. Active duty Dependents
  C. Retires
  D. B and C
  D. B and C

• Question 140:

  Identify the CORRECT statement(s):

  (A)

  Smaller the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.

  (B)

  Gender of the group's participants has no effect on the likelihood of loss.

  A. All of the listed options
  B. B and C
  C. None of the listed options
  D. A and C
  C. None of the listed options