AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 191:

  Medicare Advantage product options include:

  A. Coordinated care plans, medical savings accounts and national PPOs.

  B. Private Fee for Service plans, health care prepayment plans and medical savings accounts

  C. Coordinated care plans, regional PPOs and private fee for service plans

  D. Cost contracts, coordinated care programs and medical savings accounts.

  Correct Answer: C

• Question 192:

  Primary care case managers (PCCMs) provide managed healthcare services to eligible Medicaid recipients. With regard to PCCMs, it is correct to say that

  A. PCCMs contract directly with the federal government to provide case management services to Medicaid recipients

  B. all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs

  C. Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

  D. PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients

  Correct Answer: C

• Question 193:

  One ethical principle in health plans is the principle of non-malfeasance, which holds that health plans and their providers:

  A. Should allocate resources in a way that fairly distributes benefits and burdens among the members.

  B. Have a duty to present information honestly and are obligated to honor commitments.

  C. Are obligated not to harm their members.

  D. Should treat each plan member in a manner that respects his or her goals and values.

  Correct Answer: C

• Question 194:

  Natalie Chan is a member of the Ultra Health Plan. Whenever she needs non-emergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a specialist, so she saw Dr. Craig when she experienced headaches. Dr. Craig referred

  A. Within Ultra's system, Ms. Chan received primary care from both Dr. Craig and Dr. Lee.

  B. Ultra's system allows its members open access to all of Ultra's participating providers.

  C. Within Ultra's system, Dr. Craig serves as a coordinator of care or gatekeeper for the medical services that Ms. Chan receives.

  D. Ultra's network of providers includes Dr. Craig and Dr. Lee but not Arrow Hospital.

  Correct Answer: C

• Question 195:

  Most contracts between health plans and providers contain a provision which forbids providers from seeking compensation from patients if the health plan fails to compensate the provider because of insolvency or for any other reason. Such a provision is kn

  A. due process provision

  B. cure provision

  C. hold-harmless provision

  D. risk-sharing provision

  Correct Answer: C

• Question 196:

  Individuals can use HSAs to pay for the following types of health coverage:.

  A. Qualified disability insurance

  B. COBRA continuation coverage.

  C. Medigap coverage (for those over 65).

  D. All of the above.

  Correct Answer: B

• Question 197:

  Lansdale Healthcare, a health plan, offers comprehensive healthcare coverage to its members through a network of physicians, hospitals, and other service providers. Plan members who use in-network services pay a copayment for these services. The copayment

  A. specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered

  B. percentage of the fees for medical services that a plan member must pay after Magellan has paid its share of the costs of those services

  C. flat amount that a plan member must pay each year before Magellan will make any benefit payments on behalf of the plan member

  D. specified payment for services that was negotiated between the provider and Magellan

  Correct Answer: A

• Question 198:

  Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

  A. Acquisition of the Leopard Health Plan by the Hickory Health Plan.

  B. Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

  C. Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

  D. Consolidation of the Carver Health Plan and the Limestone Health Plan.

  Correct Answer: C

• Question 199:

  Several marketplace factors helped fuel the movement toward consumer choice. Which one of the following statements is NOT accurate with regard to these factors?

  A. After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.

  B. During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.

  C. Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.

  D. Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.

  Correct Answer: A

• Question 200:

  The following statement can be correctly made about Medicare Advantage eligibility:

  A. Individuals enrolled in a MA plan must enroll in a stand-alone Part D prescription drug plan.

  B. Individuals enrolled in a MA plan do not have to be eligible for Medicare Part A

  C. Individuals enrolled in an MSA plan or a PFFS plan without Medicare drug coverage can enroll in Medicare Part D.

  D. Individuals can enroll in MA plan in multiple regions.

  Correct Answer: C