AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 131:

  The main advantage of using outcomes measures to evaluate healthcare quality is that they Typically

  A. are easy to identify and report

  B. demonstrate improved clinical and functional status over time

  C. are insensitive to changes in structures or processes

  D. provide meaningful feedback on care delivery even when the delay between treatment and outcome stretches over several years

  Correct Answer: B

• Question 132:

  In order to measure the expenses of institutional utilization, Holt Health care group uses standard formula to calculate hospital bed stays per 1000 plan members. On 26 November, Holt uses the following information to:

  Calculate the bed days per 1000 members for the MTD Total gross hospital bed days in MTD = 500 Plan membership = 15000 Calculate Holt's number of bed days per 1000 members for the month to date, rounded to the nearest

  whole number.

  A. 468

  B. 365

  C. 920

  D. 500

  Correct Answer: A

• Question 133:

  The following statements are about concepts related to the underwriting function within a health plan. Select the answer choice containing the correct statement.

  A. Anti selection refers to the fact that individuals who believe that they have a less-than- average likelihood of loss tend to seek healthcare coverage to a greater extent than do individuals who believe that they have an average or greater-than-average like

  B. Federally qualified HMOs are required to medically underwrite all groups applying for coverage.

  C. Typically, a health plan guarantees the premium rate for a group health contract for a period of five years.

  D. When evaluating the risk for a group policy, underwriters typically focus on such factors as the size of the group, the stability of the group, and the activities of the group.

  Correct Answer: D

• Question 134:

  The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Select the answer choice containing the correct statement.

  A. In most preferred provider organizations (PPOs) and open access plans, plan members must receive a referral before accessing behavioral healthcare services from a specialist.

  B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) typically use alternative treatment levels and alternative treatment methods rather than crisis intervention or alternative treatment settings.

  C. Managed behavioral health organizations (MBHOs) typically are prohibited from negotiating with network providers for reduced fees in exchange for increased patient volume.

  D. The treatment approaches for behavioral healthcare most often include drug therapy, psychotherapy, and counseling.

  Correct Answer: B

• Question 135:

  What are the characteristics that the underwriter has to consider while determining the premium rate for health insurance coverage for a group?

  A. Level of benefits

  B. Geographic location

  C. Group size

  D. All the above

  Correct Answer: D

• Question 136:

  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

  Correct Answer: C

• Question 137:

  Consolidation of patient information in a single location as can be used by independent providers is an example of

  A. Structural Integration

  B. Operational Integration

  C. Business Integration

  D. None of the above

  Correct Answer: D

• Question 138:

  Which of the following statements about EPO and HMO models is FALSE?

  A. In-network visit is allowed only on PCP's referral in HMO model.

  B. Out-of-network visit is not allowed in HMO model.

  C. Out-of-network visit is not allowed in EPO model.

  D. In-network visit is allowed only on PCP's referral in EPO model.

  Correct Answer: A

• Question 139:

  The Polestar Company's sole business is the ownership of Polaris Medical Group, a health plan and subsidiary of Polestar. Some members of Polestar's board of directors hold positions with Polestar in addition to their positions on the board; the rest are professionals in academia and businesspeople who do not work for Polestar. Dr. Carolyn Porter, a university president, is on Polestar's board. From the following answer choices, select the response containing the term that correctly identifies Polestar's relationship to Polaris and the term that describes the type of board member represented by Dr. Porter

  A. Polestar's relationship to Polaris: partnership: Type of board member: operations director

  B. Polestar's relationship to Polaris: partnership: Type of board member: outside director

  C. Polestar's relationship to Polaris: holding company: Type of board member: operations director

  D. Poles tar's relationship to Polaris: holding company: Type of board member: outside director

  Correct Answer: D

• Question 140:

  Using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider is called ______________.

  A. Coding error

  B. Overcharging

  C. Upcoming

  D. Unbundling

  Correct Answer: C