AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 181:

  Which of the choices below contains the four tools used by marketers that make up the 'promotion mix'?

  A. Advertising, personal selling, sales promotion, and publicity.
  B. Advertising, price, sales promotion, and publicity.
  C. Admissions, personal selling, sales promotion, and publicity.
  D. Advertising, personal selling, sales promotion, and privacy.
  A. Advertising, personal selling, sales promotion, and publicity.

• Question 182:

  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
  C. more acceptable to physicians

• Question 183:

  Which of the following is an example of physician only model of operational integration?

  A. Consolidated medical group
  B. Integrated Delivery System
  C. Medical Foundation
  D. Both B and C
  A. Consolidated medical group

• Question 184:

  The NAIC adopted the HMO Model Act in order to provide a system of ongoing regulatory monitoring of HMOs. All of the following statements are correct about the HMO Model Act EXCEPT that it:

  A. Regulates HMO operations in two critical areas: financial responsibility and healthcare delivery.
  B. Requires each HMO to send state regulators an annual report describing the HMO's finances and operations.
  C. Focuses on three key aspects of healthcare delivery: network adequacy, quality assurance, and grievance procedures.
  D. Requires state insurance departments to conduct annual examinations of an HMO's operations, quality assurance programs, and provider networks.
  D. Requires state insurance departments to conduct annual examinations of an HMO's operations, quality assurance programs, and provider networks.

• Question 185:

  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
  B. Relative value scale (RVS)

• Question 186:

  In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care.

  A. A, B, and C
  B. A and B only
  C. A and C only
  D. B only
  D. B only

• Question 187:

  Because many patients with behavioral health disorders do not require round-the-clock nursing care and supervision, behavioral healthcare services can be delivered effectively in a variety of settings. For example, post-acute care for behavioral health di

  A. Hospital observation units or psychiatric hospitals.
  B. Psychiatric hospitals or rehabilitation hospitals.
  C. Subacute care facilities or skilled nursing facilities.
  D. Psychiatric units in general hospitals or hospital observation units.
  C. Subacute care facilities or skilled nursing facilities.

• Question 188:

  One characteristic of disease management programs is that they typically

  A. focus on individual episodes of medical care rather than on the comprehensive care of the patient over time
  B. are used to coordinate the care of members with any type of disease, either chronic or nonchronic
  C. focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition
  D. use clinical practice processes to standardize the implementation of best practices among providers
  D. use clinical practice processes to standardize the implementation of best practices among providers

• Question 189:

  Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billi

  A. prevent Dr. Ware from requiring a Riverside member to pay any coinsurance, copayment, or deductibles that the member would normally pay under Riverside's plan
  B. require Dr. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts
  C. prevent Dr. Ware from seeking compensation from patients if Riverside fails to compensate him because of the MCO's insolvency
  D. prevent Dr. Ware from billing a Riverside member for medical services that are not included in Riverside's plan
  B. require Dr. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts

• Question 190:

  In addition to the credentialing activities that an health plan performs when initially accepting a provider into its network, the health plan must also perform recredentialing of the same providers on an ongoing basis. Many of the same activities are per

  A. verification of a network provider's medical education and residency
  B. performance of site inspections in a provider's facilities
  C. review of information from a provider's quality improvement activities
  D. verification of a provider's licensure and certification
  A. verification of a network provider's medical education and residency