AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 171:

  A health plan may use one of several types of community rating methods to set premiums for a health plan. The following statements are about community rating. Select the answer choice containing the correct statement.

  A. Standard (pure) community rating is typically used for large groups because it is the most competitive rating method for large groups.
  B. Under standard (pure) community rating, a health plan charges all employers or other group sponsors the same dollar amount for a given level of medical benefits or health plan, without adjusting for factors such as age, gender, or experience.
  C. In using the adjusted community rating (ACR) method, a health plan must consider the actual experience of a group in developing premium rates for that group.
  D. The Centers for Medicare and Medicaid Services (CMS) prohibits health plans that assume Medicare risk from using the adjusted community rating (ACR) me
  B. Under standard (pure) community rating, a health plan charges all employers or other group sponsors the same dollar amount for a given level of medical benefits or health plan, without adjusting for factors such as age, gender, or experience.

• Question 172:

  From the following answer choices, choose the description of the ethical principle that best corresponds to the term Beneficence

  A. Health plans and their providers are obligated not to harm their members
  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group
  C. Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members
  D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives
  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

• Question 173:

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

• Question 174:

  The act which requires each group health plan to allow employees and certain dependents to continue their group coverage for a stated period of time following a qualifying event that causes the loss of group health coverage is:

  A. ERISA
  B. COBRA
  B. COBRA

• Question 175:

  Disease management is typically set up as a voluntary outreach and support program for plan members with certain _________ diseases

  A. Acute
  B. Chronic
  C. None of the above
  B. Chronic

• Question 176:

  In claims administration terminology, a claims investigation is correctly defined as the process of

  A. reporting management information about services provided each time a patient visits a provider for purposes of analyzing utilization and provider practice patterns
  B. obtaining all the information necessary to determine the appropriate amount to pay on a given claim
  C. routinely reviewing and processing a claim for either payment or denial
  D. assigning to each diagnosis or treatment reported on a claim special codes that briefly and specifically describe each diagnosis and treatment
  B. obtaining all the information necessary to determine the appropriate amount to pay on a given claim

• Question 177:

  In 1999, the United States Congress passed the Financial Services Modernization Act, which is referred to as the Gramm-Leach-Bliley (GLB) Act. The following statement(s) can correctly be made about this act:

  A. The GLB Act allows convergence among the transaction
  B. A only
  C. Both A and B
  D. B only
  E. Neither A nor B
  B. A only

• Question 178:

  When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previous

  A. 230
  B. 270
  C. 220
  D. 180
  C. 220

• Question 179:

  A differences between managed indemnity and traditional indemnity

  A. Include precertification and utilization review techniques
  B. Both are the same
  C. Include network and quality review techniques
  D. A and B
  C. Include network and quality review techniques

• Question 180:

  Ronald Canton is a member of the Omega MCO. He receives his nonemergency medical care from Dr. Kristen High, an internist. When Mr. Canton needed to visit a cardiologist about his irregular heartbeat, he first had to obtain a referral from Dr. High to see

  A. Dr. High serves as the coordinator of care for the medical services that Mr. Canton receives.
  B. Omega's network of providers includes Dr. High, but not Dr. Miller.
  C. Omega's system allows its members open access to all of Omega's participating providers.
  D. Omega used a financing arrangement known as a relative value scale (RVS) to compensate Dr. Miller.
  A. Dr. High serves as the coordinator of care for the medical services that Mr. Canton receives.