AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 191:

  The Military Health System of the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the

  A. Health Care Quality Improvement Program (HCQIP)
  B. Health Plan Management System (HPMS)
  C. TRICARE healthcare system
  D. Health Care Prepayment Plan (HCPP)
  C. TRICARE healthcare system

• Question 192:

  The owners of an MCO typically delegate authority for governing the operation of the MCO by electing the MCO's

  A. quality management committee
  B. medical director
  C. board of directors
  D. chief executive officer
  C. board of directors

• Question 193:

  One way in which health plans differ from traditional indemnity plans is that health plans typically

  A. provide less extensive benefits than those provided under traditional indemnity plans
  B. place a greater emphasis on preventive care than do traditional indemnity plans
  C. require members to pay a percentage of the cost of medical services rendered after a claim is filed, rather than a fixed copayment at the time of service as required by indemnity plans
  D. contain cost-sharing requirements that result in more out-of-pocket spending by members than do the cost-sharing requirements in traditional indemnity plans
  B. place a greater emphasis on preventive care than do traditional indemnity plans

• Question 194:

  A medical foundation is a not-for-profit entity that purchases and manages physician practices. In order to retain its not-for-profit status, a medical foundation must

  A. Provide significant benefit to the community
  B. Employ, rather than contract with, participating physicians
  C. Achieve economies of scale through facility consolidation and practice management
  D. Refrain from the corporate practice of medicine
  A. Provide significant benefit to the community

• Question 195:

  One device that PBM plans use to manage both the cost and use of pharmaceuticals is a formulary. A formulary is defined as

  A. a listing of drugs classified by therapeutic category or disease class that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications
  B. a reduction in the price of a particular pharmaceutical obtained by the PBM from the pharmaceutical manufacturer
  C. drugs ordered and delivered through the mail to the PBM's plan members at a reduced cost
  D. an identification card issued by the PBM to its plan members
  A. a listing of drugs classified by therapeutic category or disease class that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications

• Question 196:

  One of the most influential pieces of legislation in the advancement of managed care within the United States was the HMO Act of 1973. One provision of the HMO Act of 1973 was that it

  A. emphasized compensating physicians based solely on the volume of medical services they provide
  B. exempted HMOs from all state licensure requirements
  C. established a process under which HMOs could elect to be federally qualified
  D. required federally qualified HMOs to relate premium levels to the health status of the individual enrollee or employer group
  C. established a process under which HMOs could elect to be federally qualified

• Question 197:

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

  A. Deductible
  B. Copayment
  C. Capitation
  D. Co-insurance
  B. Copayment

• Question 198:

  In order to measure the expenses of institutional utilization, Holt Health care group uses standard formula to calculate hospital bed stays per 1000 plan members. On 26 November, Holt uses the following information to: Calculate the bed days per 1000 members for the MTD Total gross hospital bed days in MTD = 500 Plan membership = 15000 Calculate Holt's number of bed days per 1000 members for the month to date, rounded to the nearest whole number.

  A. 468
  B. 365
  C. 920
  D. 500
  A. 468

• Question 199:

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

  The Iota 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 practice

  A. Iota- physician hospital organization (PHO)Casa- physician practice management (PPM) company.
  B. Iota- physician hospital organization (PHO)Casa- medical foundation.
  C. Iota- physician practice management (PPM) Casa- physician hospital organization (PHO) company.
  D. Iota- medical foundation Casa- management services organization (MSO).
  C. Iota- physician practice management (PPM) Casa- physician hospital organization (PHO) company.

• Question 200:

  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
  A. A, B, C, and D