AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 211:

  Paul Gilbert has been covered by a group health plan for two years. He has been undergoing treatment for angina for the past three months. Last week, Mr. Gilbert began a new job and immediately enrolled in his new company's group health plan, which has a

  A. Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.

  B. Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because Mr. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.

  C. Can exclude coverage for treatment of Mr. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.

  D. Cannot exclude his angina as a pre-existing condition, because the one-year preexisting condition provision is offset by at least one year of continuous coverage under his previous health plan.

  Correct Answer: D

• Question 212:

  Parul Gupta has been covered by a group health plan for eighteen months. For the past four months, she has been undergoing treatment for diabetes. Last week, Ms. Gupta began a new job and immediately enrolled in her new company's group health plan, which

  A. can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because she did not have at least two years of creditable coverage under her previous health plan

  B. cannot exclude Ms. Gupta's diabetes as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under her previous health plan

  C. can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because HIPAA does not impact a group health plan's pre-existing condition provision

  D. can exclude coverage for treatment of Ms. Gupta's diabetes for four months, because that is the length of time she received treatment for this medical condition prior to her enrollment in the new health plan

  Correct Answer: B

• Question 213:

  The Azure Group is a for-profit health plan that operates in the United States. The Fordham Group owns all of Azure's stock. The Fordham Group's sole business is the ownership of controlling interests in the shares of other companies. This information ind

  A. A holding company of the Fordham Group.

  B. A sister corporation of the Fordham Group.

  C. A subsidiary of the Fordham Group.

  D. All of the above.

  Correct Answer: C

• Question 214:

  One true statement regarding ethics and laws is that the values of a community are reflected in

  A. both ethics and laws, and both ethics and laws are enforceable in the court system

  B. both ethics and laws, but only laws are enforceable in the court system

  C. ethics only, but only laws are enforceable in the court system

  D. laws only, but both ethics and laws are enforceable in the court system

  Correct Answer: B

• Question 215:

  John Kerry's employer has contracted to receive healthcare for its employees from the Democratic Healthcare System. Mr. Kerry visits his PCP, who sends him to have some blood tests. The PCP then refers Mr. Kerry to a specialist who hospitalizes him for on

  A. a physician practice organization

  B. a physician-hospital organization

  C. a management services organization

  D. an integrated delivery system

  Correct Answer: D

• Question 216:

  The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. Advances in computer technology have revolutionized the

  processing of medical and drug claims. Claims processing i

  A. Lower

  B. Higher

  C. Same

  D. No change

  Correct Answer: B

• Question 217:

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

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

  With regard to the UM programs, it is most likely cor

  A. self-care program is intended to complement physicians' services, rather than to supercede or eliminate these services

  B. telephone triage program is staffed by physicians only

  C. shared decision-making program is appropriate for virtually any medical condition

  D. preventive care initiatives include immunization programs but not health promotion programs

  Correct Answer: A

• Question 218:

  One distinguishing characteristic of a health maintenance organization (HMO) is that, typically, an HMO

  A. arranges for the delivery of medical care and provides, or shares in providing, the financing of that care

  B. must be organized on a not-for-profit basis

  C. may be organized as a corporation, a partnership, or any other legal entity

  D. must be federally qualified in order to conduct business in any state

  Correct Answer: A

• Question 219:

  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

  Correct Answer: D

• Question 220:

  Many of the credentialing standards and criteria used by health plans are often taken from already existing standards established by

  A. the National Practitioner Data Bank (NPDB)

  B. the National Association of Insurance Commissioners (NAIC)

  C. the Centers for Medicare and Medicaid Services (CMS)

  D. independent accrediting organizations

  Correct Answer: D