AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 201:

  The following programs are part of the Alcove Health Plan's utilization management (UM) program:

  Preventive care initiatives A telephone triage program A shared decision-making program A self-care program

  With regard to the UM programs, it is most

  A. Preventive care initiatives include immunization programs but not health promotion programs.
  B. Telephone triage program is staffed by physicians only.
  C. Shared decision-making program is appropriate for virtually any medical condition.
  D. Self-care program is intended to complement physicians' services, rather than to supersede or eliminate these services.
  D. Self-care program is intended to complement physicians' services, rather than to supersede or eliminate these services.

• Question 202:

  One ethical principle in managed care is the principle of justice/equity, which specifically holds that MCOs and their providers have a duty to

  A. treat each member in a manner that respects his or her own goals and values
  B. allocate resources in a way that fairly distributes benefits and burdens among the members
  C. present information honestly to their members and to honor commitments to their members
  D. make sure they do not harm their members
  B. allocate resources in a way that fairly distributes benefits and burdens among the members

• Question 203:

  A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services. With regard to the steps that the health plan's claims e

  A. should assume that all services requiring preauthorization have been preauthorized
  B. should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim
  C. need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits
  D. need not determine whether the member is covered by another health plan that allows for coordination of benefits
  B. should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim

• Question 204:

  A public employer, such as a municipality or county government would be considered which of the following?

  A. Employer-employee group
  B. Multiple-employer group
  C. Affinity group
  D. Debtor-creditor group
  A. Employer-employee group

• Question 205:

  The following statements are about issues associated with marketing healthcare plans to small groups and large groups. Select the answer choice that contains the correct statement.

  A. In the large group market, large group accounts that have employees in more than one geographic area who are covered through a single national contract for healthcare coverage are known as large local groups.
  B. Because providing healthcare coverage for employees is often a burden for small businesses, price is typically the most critical consideration for small businesses in selecting a healthcare plan.
  C. health plans typically treat an employer purchasing coalition as a small group for marketing purposes.
  D. Large groups rarely use self-funding to finance their healthcare plans.
  B. Because providing healthcare coverage for employees is often a burden for small businesses, price is typically the most critical consideration for small businesses in selecting a healthcare plan.

• Question 206:

  Member satisfaction is a critical element of a health plan's quality management program. A health plan can obtain information about member satisfaction with various aspects of the health plan from

  A. surveys completed by members following a visit to a provider
  B. surveys sent to plan members who have not received healthcare services during a specified time period
  C. periodic reports of complaints received by member services personnel
  D. all of the above
  D. all of the above

• Question 207:

  Using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider is called ______________.

  A. Coding error
  B. Overcharging
  C. Upcoming
  D. Unbundling
  C. Upcoming

• Question 208:

  Wellborne HMO provides health-related information to its plan members through an Internet Web site. Laura Knight, a Wellborne plan member, visited Wellborne's Web site to gather uptodate information about the risks and benefits of various treatment option

  A. shared decision making
  B. self-care
  C. preventive care
  D. triage
  A. shared decision making

• Question 209:

  The prudent layperson standard described in the Balanced Budget Act (BBA) of 1997 requires all hospitals that receive Medicare or Medicaid reimbursement to screen and, if necessary, stabilize all patients who come to their emergency departments.

  A. True
  B. False
  B. False

• Question 210:

  Advantages of EDI over manual data management systems

  A. Speed of data refer
  B. Loss of data integrity
  C. All of the above
  D. None of the above
  B. Loss of data integrity