AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 141:

  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 142:

  The following statements are about standards set forth in the Quality Improvement System for Managed Care (QISMC), established by the Health Care Financing Administration (HCFA, now known as the Centers for Medicare and Medicaid Services).

  A. As a result of the Balanced Budget Refinement Act (BBRA), PPOs are required to meet all QISMC quality requirements.

  B. QISMC standards typically do not apply to such Medicare services as mental health or substance abuse services.

  C. Medicaid primary care case manager (PCCM) programs are subject to the same QISMC quality standards and performance measures as are all other Medicare and Medicaid programs.

  D. QISMC standards and guidelines are required for Medicare MCOs, but they are applicable to Medicaid MCOs at the discretion of the individual states.

  Correct Answer: D

• Question 143:

  Arrange the following provider organizations in the order ranging from least integrated.

  I. Physician Practice Management (PPM) company

  II. Integrated Delivery System (IDS)

  III. Group Practice Without Walls (GPWW)

  IV.

  Independent Practice Association (IPA)

  A.

  I, II, III, IV

  B.

  IV, III, I, II

  C.

  I, II, IV, III

  D.

  I, IV, II, III

  Correct Answer: B

• Question 144:

  The following statements are about health information networks (HINs). Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement.

  A. Most HINs are built on proprietary computer networks rather than being Internet based.

  B. While a HIN is for the exclusive use of one organization, a community health information network (CHIN) is shared by several organizations.

  C. A health plan can use a secured extranet design or a distributed database approach for its HIN.

  D. HINs have the potential to increase the quality of medical care because they make a patient's medical history readily available to each provider at the point of service.

  Correct Answer: A

• Question 145:

  Utilization data can be transmitted to the health plan manually, by telephone, or electronically. Compared to other methods of data transmittal, manual transmittal is generally

  A. less cumbersome and labor intensive

  B. faster and more accurate

  C. more acceptable to physicians

  D. subject to greater scrutiny by regulatory bodies

  Correct Answer: C

• Question 146:

  The following statements describe healthcare services delivered to health plan members by plan providers. Select the statement that describes a service that would most likely require utilization review and authorization.

  A. Adele Farnsworth visited a dermatologist to have a mole removed from her arm.

  B. Jonathan Lang underwent an electrocardiogram (EKG) during an office visit with his cardiologist.

  C. Corinne Maxwell underwent physical therapy after being hospitalized for hip replacement surgery.

  D. Jose Redriguez, a 70-year-old Medicare patient, received a flu shot as part of his annual physical examination.

  Correct Answer: C

• Question 147:

  Which of the following is WRONG?

  A. Computer Based Patient Records Institute (CPRI) developed the standards for digital imaging of xrays.

  B. HL7 developers focuses on interchange of Clinical Health Data

  C. ANSI, a voluntary national standards organization, creates a consensus based process by which fair and equitable standards can be developed and serves as a legitmizer of standards.

  D. American Health Information Management Association focuses on EDI standards for exchange of clinical data

  Correct Answer: A

• Question 148:

  Which of the following statements is NOT a requirement for a service to be deemed a 'medically necessary service'?

  A. Furnished in the least intensive type of medical care setting required by the member's condition.

  B. Solely for the convenience of the member.

  C. In accordance with the standards of good medical practice.

  D. Consistent with the symptoms of the member's condition.

  Correct Answer: B

• Question 149:

  The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Three of these statements are true and one statement is false. Select the answer choice

  A. Factors that have increased the demand for behavioral healthcare services include increased stress on individuals and families and the increasing availability of behavioral healthcare services.

  B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) use only two basic strategies: alternative treatment levels and crisis intervention.

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

  D. The development of alternative treatment options, incorporation of community-based resources into the healthcare system, and increased reliance on case management have shifted the emphasis of managed behavioral healthcare from meeting the service needs of

  Correct Answer: B

• Question 150:

  Salient features of a Health Savings Account include all of the following except

  A. Funding by both employer and the employee

  B. Employer account ownership

  C. Account portability and roll over of funds from year to year

  D. Investment opportunities

  Correct Answer: B