AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 161:

  Common characteristics of POS products are

  A. Lack of Freedom of choice

  B. Absence of Primary care physician

  C. Cost-cutting efforts and the structure of coverage

  D. All of the above

  Correct Answer: C

• Question 162:

  Each time a patient visits a provider he has to pay a fixed dollar amount?

  A. Deductible

  B. Copayment

  C. Capitation

  D. Co-insurance

  Correct Answer: B

• Question 163:

  The situation wherein two hospitals agree to each refuse to contract with a health plan until the health plan cease contract negotiations with a competing hospital is known as

  A. Horizontal division of markets

  B. Tying arrangements

  C. Horizontal group boycott

  D. Price fixing

  Correct Answer: C

• Question 164:

  High deductible health plans (HDHP) are characterized by all of the following features except

  A. A HDHPs have a higher deductible than other traditional insurance products such as HMOs and PPOs.

  B. HDHPs generally cost more than traditional heathcare coverage.

  C. Some HDHPs cover preventive care on a first-dollar coverage basis.

  D. All of the above

  Correct Answer: A

• Question 165:

  The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

  A. Has ever participated in any quality improvement activities.

  B. Is a participating provider in a health plan that will compete with Ark in its new service area.

  C. Meets the requirements of the Ethics in Patient Referrals Act.

  D. Has had a medical malpractice claim filed or other disciplinary actions taken against her.

  Correct Answer: D

• Question 166:

  The following statements describe violations of antitrust legislation:

  Situation A - Two health plans in a single service area divided purchasers into two groups and agreed to

  each market their products to only one purchaser group. Situation B - A spec

  A. Situation A - horizontal division of markets Situation B - tying arrangement.

  B. Situation A - horizontal division of markets Situation B - price fixing.

  C. Situation A - horizontal group boycott Situation B - tying arrangement.

  D. Situation A - horizontal group boycott Situation B - price fixing.

  Correct Answer: A

• Question 167:

  Advantages of EDI over manual data management systems

  A. Speed of data refer

  B. Loss of data integrity

  C. All of the above

  D. None of the above

  Correct Answer: B

• Question 168:

  Which of the following is CORRECT?

  A. Electronic transmittal of authorization is subject to the same regulatory requirements as other methods of transmittal

  B. Telephone transmittal increases data entry errors.

  C. Medical review is conducted before administrative review.

  D. Prospective review, concurrent review and retrospective review are types of utilization review

  Correct Answer: D

• Question 169:

  Katrina Lopez is a claims analyst for a health plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Ms. Lopez reviewed a health claim for answers to the following questions:

  A. A, B, C, and D

  B. A, B, and D only

  C. B, C, and D only

  D. A and C only

  Correct Answer: A

• Question 170:

  The Conquest Corporation contracts with the Apex health plan to provide basic medical and surgical services to Conquest employees. Conquest entered into a separate contract with the Bright Dental Group to provide and manage a dental care program for employee

  A. a negotiated rebate agreement

  B. a carve-out arrangement

  C. an indemnity plan

  D. PBM

  Correct Answer: B