AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 211:

  Natalie Chan is a member of the Ultra Health Plan, a health plan. Whenever she needs nonemergency 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. Cr

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

• Question 212:

  Mr. George Bush is covered by a PBM plan that uses a closed formulary. This indicates that

  A. he can receive coverage for pharmaceuticals only if they are on the PBM plan's preferred list of drugs
  B. he must receive all of his pharmaceuticals from a mail-order pharmacy program
  C. he can receive coverage for pharmaceuticals that are on the PBM plan's preferred list of drugs, as well as for pharmaceuticals that are not on the preferred list
  D. the PBM plan cannot receive a rebate on any pharmaceuticals it obtains from the pharmaceutical facture
  A. he can receive coverage for pharmaceuticals only if they are on the PBM plan's preferred list of drugs

• Question 213:

  As part of its quality management program, the Lyric Health Plan regularly compares its practices and services with those of its most successful competitor. When Lyric concludes that its competitor's practices or services are better than its own, Lyric im

  A. Benchmarking.
  B. Standard of care.
  C. An adverse event.
  D. Case-mix adjustment.
  A. Benchmarking.

• Question 214:

  The Fairway Health Group contracted with the Empire Corporation to provide behavioral healthcare services to Empire employees. As a condition of providing behavioral healthcare services, Fairway required Empire to contract with Fairway for basic medical so

  A. horizontal group boycott
  B. price-fixing agreement
  C. horizontal division of markets
  D. tying arrangement
  D. tying arrangement

• Question 215:

  The following types of CDHPs allow federal tax advantages including the ability to roll funds from one year to the next:

  A. MSAs, HRAs, HSAs
  B. FSAs, MRAs, HRAs
  C. FSAs, HRAs, HSAs
  D. FSAs, MRAs HSAs
  A. MSAs, HRAs, HSAs

• Question 216:

  The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the hi

  A. $60
  B. $80
  C. $120
  D. $160
  B. $80

• Question 217:

  The following programs are typically included in TRICARE medical management efforts:

  A. A and B only
  B. A and C only
  C. All of the listed options
  D. B and C only
  C. All of the listed options

• Question 218:

  Janet Riva is covered by a indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred $2,500 in medical expenses that were covered by her health plan. She incurred

  A. $1,750
  B. $1,800
  C. $2,000
  D. $2,250
  B. $1,800

• Question 219:

  In order to help review its institutional utilization rates, the Sahalee Medical Group, a health plan, uses the standard formula to calculate hospital bed days per 1,000 plan members for the month to date (MTD). On April 20, Sahalee used the following inf

  B. 274
  C. 365
  D. 1,000
  B. 274

• Question 220:

  As part of its utilization management (UM) system, the Creole Health Plan uses a process known as case management. The following individuals are members of the Creole Health Plan:

  Jill Novacek, who has a chronic respiratory condition. Abraham Rashad.

  A. Ms. Novacek, Mr. Rashad, and Mr. Devereaux
  B. Ms. Novacek and Mr. Rashad only
  C. Ms. Novacek and Mr. Devereaux only
  D. None of these members
  A. Ms. Novacek, Mr. Rashad, and Mr. Devereaux