AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 201:

  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

  Correct Answer: B

• Question 202:

  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

  Correct Answer: D

• Question 203:

  The existing committees at the Majestic Health Plan, a health plan that is subject to the requirements of HIPAA, include the Executive Committee and the Corporate Compliance Committee. The Executive Committee serves as a long-term advisory body on issues

  A. Both 1 and 2

  B. 1 only

  C. 2 only

  D. Neither 1 nor 2

  Correct Answer: B

• Question 204:

  One way in which a health plan can support an ethical environment is by

  A. requiring organizations with which it contracts to adopt the plan's formal ethical policy

  B. developing and maintaining a culture where ethical considerations are integrated into decision making at the top organizational level only

  C. establishing a formal method of managing ethical conflicts, such as using an ethics task force or bioethics consultant

  D. maintaining control of policy development by removing providers and members from the process of

  developing and implementing policies and procedures that provide guidance to providers and members confronted with ethical issues

  Correct Answer: C

• Question 205:

  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.

  Correct Answer: A

• Question 206:

  The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. In early efforts to manage healthcare costs, traditional indemnity health insurers included in their health pla

  A. cost shifting

  B. deductibles

  C. underwriting

  D. copy

  Correct Answer: B

• Question 207:

  In the United States, the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the TRICARE health plan. One true statement about TRICARE is that

  A. hospitals participating in TRICARE program are exempt from JCAHO accreditation and Medicare certification

  B. TRICARE enrollees are not entitled to appeal authorization coverage decisions

  C. active duty personnel are automatically considered enrolled in TRICARE Prime

  D. TRICARE covers inpatient and outpatient services, physician and hospital charges, and medical supplies, but not mental health services

  Correct Answer: C

• Question 208:

  In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice containing the two terms that you have chosen. For providers, (operational /

  A. operational / an acquisition

  B. operational / a consolidation

  C. structural / an acquisition

  D. structural / a consolidation

  Correct Answer: D

• Question 209:

  Some providers use electronic medical records (EMRs) to document their patients' care in an electronic form. The following statement(s) can correctly be made about EMRs:

  A. EMRs are computerized records of a patient's clinical, demographic, and administrator

  B. B only

  C. Both A and B

  D. Neither A nor B

  E. A only

  Correct Answer: D

• Question 210:

  Parable Healthcare Providers, a health plan, recently segmented the market for a new healthcare service. Parable began the process by dividing the healthcare market into two broad categories: non-group and group. Next, Parable further segmented the non-gr

  A. channel segmentation

  B. geographic segmentation

  C. demographic segmentation

  D. product segmentation

  Correct Answer: C