AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 151:

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

• Question 152:

  Health plans can organize under a not-for-profit form or a for-profit form. One true statement regarding not-for-profit health plans is that these organizations typically

  A. are exempt from review by the Internal Revenue Service (IRS)
  B. are organized as stock companies for greater flexibility in raising capital
  C. rely on income from operations for the large cash outlays needed to fund long-term projects and expansion
  D. engage in lobbying or political activities in order to maintain their tax-exempt status
  C. rely on income from operations for the large cash outlays needed to fund long-term projects and expansion

• Question 153:

  The following statements are about preferred provider organizations (PPOs). Select the answer choice that contains the correct statement.

  A. PPOs generally assume full financial risk for arranging medical services for their members.
  B. PPOs generally pay a larger portion of a member's medical expenses when that member uses in-network providers than when the member uses out-of-network providers.
  C. PPO networks may include primary care physicians and hospitals, but generally do not include specialists.
  D. In a PPO, the most common method used to reimburse physicians is capitation.
  B. PPOs generally pay a larger portion of a member's medical expenses when that member uses in-network providers than when the member uses out-of-network providers.

• Question 154:

  Bart Vereen is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a managed care plan. Both plans have a typical coordination of benefits (COB) provision, but neither plan has a nonduplication of benefits provision

  A. 380
  B. 130
  D. 550
  A. 380

• Question 155:

  More procedures or services may be fully covered within the PPO network than those out of network.

  A. True B. False
  A. True B. False

• Question 156:

  A health plan's ability to establish an effective provider network depends on the characteristics of the proposed service area and the needs of proposed plan members. It is generally correct to say that

  A. health plans have more contracting options if providers are affiliated with single entities than if providers are affiliated with multiple entities
  B. urban areas offer more flexibility in provider contracting than do rural areas
  C. consumers and purchasers in markets with little health plan activity are likely to be more receptive to HMOs than to loosely managed plans such as PPOs
  D. large employers tend to adopt health plans more slowly than do small companies
  B. urban areas offer more flexibility in provider contracting than do rural areas

• Question 157:

  Which of the following job descriptions best match the job of a telephone triage staff member?

  A. Check patient vitals, write prescriptions, administer drugs.
  B. Greet patients at the door, collect insurance information, schedule appointments, collect payments.
  C. Determine urgency of the condition, notify emergency department, schedule appointments, authorize referrals, provide self-care information.
  D. None of the above.
  C. Determine urgency of the condition, notify emergency department, schedule appointments, authorize referrals, provide self-care information.

• Question 158:

  Parul Gupta has been covered by a group health plan for eighteen months. For the past four months, she has been undergoing treatment for diabetes. Last week, Ms. Gupta began a new job and immediately enrolled in her new company's group health plan, which

  A. can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because she did not have at least two years of creditable coverage under her previous health plan
  B. cannot exclude Ms. Gupta's diabetes as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under her previous health plan
  C. can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because HIPAA does not impact a group health plan's pre-existing condition provision
  D. can exclude coverage for treatment of Ms. Gupta's diabetes for four months, because that is the length of time she received treatment for this medical condition prior to her enrollment in the new health plan
  B. cannot exclude Ms. Gupta's diabetes as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under her previous health plan

• Question 159:

  When determining the rates it will charge a small group, the Eagle HMO, a federally qualified HMO, divides its members into classes or groups based on demographic factors such as geography, family composition, and age. Eagle then charges all members of a

  A. Retrospective experienced rating.
  B. Adjusted community rating (ACR).
  C. Pure community rating.
  D. Standard community rating.
  B. Adjusted community rating (ACR).

• Question 160:

  In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

  A. The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.
  B. Each insurance company selling Medigap must sell all the different Medigap policies.
  C. Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.
  D. Medigap benefits vary by plan type (A through L), and are not uniform nationally.
  A. The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.