AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 161:

  Paul Gilbert has been covered by a group health plan for two years. He has been undergoing treatment for angina for the past three months. Last week, Mr. Gilbert began a new job and immediately enrolled in his new company's group health plan, which has a

  A. Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.
  B. Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because Mr. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.
  C. Can exclude coverage for treatment of Mr. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.
  D. Cannot exclude his angina as a pre-existing condition, because the one-year preexisting condition provision is offset by at least one year of continuous coverage under his previous health plan.
  D. Cannot exclude his angina as a pre-existing condition, because the one-year preexisting condition provision is offset by at least one year of continuous coverage under his previous health plan.

• Question 162:

  For this question, select the answer choice containing the terms that correctly complete the blanks labeled A and B in the paragraph below. NCQA offers Quality Compass, a national database of performance and accreditation information submitted by managed

  A. Health Plan Employer Data and Information Set (HEDIS) mandatory
  B. Health Plan Employer Data and Information Set (HEDIS) voluntary
  C. ORYX mandatory
  D. ORYX voluntary
  B. Health Plan Employer Data and Information Set (HEDIS) voluntary

• Question 163:

  The following statements describe common types of physician/hospital integrated models:

  (A)

  The Alpha Company, which is owned by a group of investors, is a for-profit legal entity that buys entire physician practices, not just the tangible assets of the

  A. Physician hospital organization physician practice management company
  B. Physician practice management company physician hospital organization
  C. Medical foundation management services company
  D. Physician hospital organization medical foundation
  B. Physician practice management company physician hospital organization

• Question 164:

  Medicaid is a jointly funded federal and state program that provides hospital and medical expense coverage to low-income individuals and certain aged and disabled individuals. One characteristic of Medicaid is that

  A. providers who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered
  B. Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all services
  C. Medicaid is always the primary payer of benefits
  D. benefits offered by Medicaid programs are federally mandated and do not vary by state
  A. providers who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered

• Question 165:

  From the following choices, choose the definition that best matches the term health risk assessment (HRA)

  A. A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves
  B. A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem
  C. A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries
  D. A technique used to evaluate the medical necessity, appropriateness, and cost- effectiveness of healthcare services for a given patient
  C. A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

• Question 166:

  The NAIC designed a small group model law to enable small groups to obtain accessible, yet affordable, group health benefits. Specifically, the model law limits the rate spread. According to this model law, if the lowest rate that an HMO charges a small g

  A. $80
  B. $120
  C. $160
  D. $240
  C. $160

• Question 167:

  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
  I. Physician Practice Management (PPM) company II. Integrated Delivery System (IDS) III. Group Practice Without Walls (GPWW) IV. Independent Practice Association (IPA)
  B. IV, III, I, II

• Question 168:

  One typical characteristic of an integrated delivery system (IDS) is that an IDS.

  A. Is more highly integrated structurally than it is operationally.
  B. Provides a full range of healthcare services, including physician services, hospital services, and ancillary services.
  C. Cannot negotiate directly with health plans, plan sponsors, or other healthcare purchasers.
  D. Performs a single business function, such as negotiating with health plans on behalf of all of the member providers.
  B. Provides a full range of healthcare services, including physician services, hospital services, and ancillary services.

• Question 169:

  The following statements are about information management in health plans. Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement:

  A. Health plans find EDI useful for transmitting data among different health plan locations.
  B. EDI is different from eCommerce in the EDI is the transfer of data, typically in batches, while ecommerce is a back-and-forth exchange of information concerning individual transactions.
  C. The majority of health plan eCommerce occurs via proprietary computer networks.
  D. Benefits that health plans can receive from using electronic data interchange.
  C. The majority of health plan eCommerce occurs via proprietary computer networks.

• Question 170:

  One HMO model can be described as an extension of a group model HMO because it contracts with multiple group practices, rather than with a single group practice. This HMO model is known as the

  A. staff model HMO
  B. IPA model HMO
  C. direct contract model HMO
  D. network model HMO
  D. network model HMO