AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 141:

  Health plans may use different capitation arrangements for different levels of service. One typical capitation arrangement provides a capitation payment that may include primary care only, or both primary and secondary care, but not ancillary services. The

  A. global capitation arrangement
  B. gatekeeper arrangement
  C. carve-out arrangement
  D. partial capitation arrangement
  D. partial capitation arrangement

• Question 142:

  The Mirror Health Plan uses a form of computer/telephony integration (CTI) to manage telephone calls coming into its member services department. When a member calls the plan's central telephone number, a device answers the call with a recorded message and

  A. a member outreach program
  B. a complaint resolution procedure (CRP)
  C. an automatic call distributor (ACD)
  D. an interactive voice response (IVR) system
  C. an automatic call distributor (ACD)

• Question 143:

  A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

  A. the specialists in the PHO are typically compensated on a capitation basis
  B. the specialists in the PHO are typically compensated on a capitation basis
  C. it typically limits the number of specialists by type of specialty
  D. it is available to a hospital's entire eligible medical staff
  E. physician membership in the PHO is limited to PCPs
  B. the specialists in the PHO are typically compensated on a capitation basis

• Question 144:

  In large health plans, management functions such as provider recruiting, credentialing, contracting, provider service, and performance management for providers are typically the responsibility of the

  A. chief executive officer (CEO)
  B. network management director
  C. board of directors
  D. director of operations
  B. network management director

• Question 145:

  FSA is funded by

  A. Employers
  B. Employee
  C. A and B
  A. Employers
  B. Employee

• Question 146:

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

• Question 147:

  One typical characteristic of preferred provider organization (PPO) benefit plans is that PPOs:

  A. Assume full financial risk for arranging medical services for their members.
  B. Require plan members to obtain a referral before getting medical services from specialists.
  C. Use a capitation arrangement, instead of a fee schedule, to reimburse physicians.
  D. Offer some coverage, although at a higher cost, for plan members who choose to use the services of non-network providers.
  D. Offer some coverage, although at a higher cost, for plan members who choose to use the services of non-network providers.

• Question 148:

  The parties to the contractual relationship that provides Castle's group health coverage to Knoll employees are

  A. Castle and Knoll only
  B. Knoll and all covered Knoll employees only
  C. Castle, Knoll, and all covered Knoll employees
  D. Castle and all covered Knoll employees only
  A. Castle and Knoll only

• Question 149:

  Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

  A. users can access the Internet using a number of different types of computer systems
  B. access to the Internet is available only to members of the health plan's network
  C. the Internet is immune to internal security breaches by employees or trading partners within the network
  D. users can contact a single controlling organization to rectify disruptions in Internet service
  A. users can access the Internet using a number of different types of computer systems

• Question 150:

  In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

  A. Therapeutic / always
  B. Generic / always
  C. Generic / never
  D. Therapeutic / never
  A. Therapeutic / always