AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 11:

  Pharmacy benefit management (PBM) companies typically interact with physicians and pharmacists by performing such clinical services as physician profiling. Physician profiling from a PBM's point of view involves

  A. ascertaining that physicians in the plan have the necessary and appropriate credentials to prescribe medications
  B. compiling data on physician prescribing patterns and comparing physicians' actual prescribing patterns to expected patterns within select drug categories
  C. monitoring patient-specific drug problems through concurrent and retrospective review
  D. establishing protocols that require physicians to obtain certification of medical necessity prior to drug dispensing
  B. compiling data on physician prescribing patterns and comparing physicians' actual prescribing patterns to expected patterns within select drug categories

• Question 12:

  George was covered by a united health care insurance policy. This policy says that Geroge has to pay $300 out of pocket for the medical expenses in that year before united health care will start to reimburse the medical expense incurred for George. What is the term used to call the out of pocket payment made by George.

  A. Co-payment
  B. Deductible
  C. Coinsurance
  D. None of the above
  B. Deductible

• Question 13:

  From the following choices, choose the definition that best matches the term Screening

  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
  B. A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

• Question 14:

  For providers, integration occurs when two or more previously separate providers combine under common ownership or control, or when two or more providers combine business operations that they previously carried out separately and independently. Such provi

  A. higher costs for health plans, healthcare purchasers, and healthcare consumers
  B. improved provider contracting position with health plans
  C. an increase in providers' autonomy and control over their own work environment
  D. all of the above
  B. improved provider contracting position with health plans

• Question 15:

  By definition, the marketing process of defining a certain place or market niche for a product relative to competitors and their products and then using the marketing mix to attract certain market segments is known as

  A. branding
  B. positioning
  C. database marketing
  D. personal selling
  B. positioning

• Question 16:

  The contract between an employer and an insurer or other TPA is called

  A. Claims
  B. Bond
  C. ASO
  D. None of the above
  C. ASO

• Question 17:

  Salient features of a Health Savings Account include all of the following except

  A. Funding by both employer and the employee
  B. Employer account ownership
  C. Account portability and roll over of funds from year to year
  D. Investment opportunities
  B. Employer account ownership

• Question 18:

  The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Select the answer choice containing the correct statement.

  A. In most preferred provider organizations (PPOs) and open access plans, plan members must receive a referral before accessing behavioral healthcare services from a specialist.
  B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) typically use alternative treatment levels and alternative treatment methods rather than crisis intervention or alternative treatment settings.
  C. Managed behavioral health organizations (MBHOs) typically are prohibited from negotiating with network providers for reduced fees in exchange for increased patient volume.
  D. The treatment approaches for behavioral healthcare most often include drug therapy, psychotherapy, and counseling.
  B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) typically use alternative treatment levels and alternative treatment methods rather than crisis intervention or alternative treatment settings.

• Question 19:

  Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

  A. an integrated delivery system (IDS)
  B. a Management Services Organization (MSO)
  C. a Physician Practice Management (PPM) company
  D. a physician-hospital organization (PHO)
  A. an integrated delivery system (IDS)

• Question 20:

  Before the Hill Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

  A. Receive compensation based on the volume and variety of medical services they perform for Hill plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services.
  B. Have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy.
  C. Receive from the IPA the same monthly compensation for each Hill plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees.
  D. Receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges.
  C. Receive from the IPA the same monthly compensation for each Hill plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees.