AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 221:

  The National Committee for Quality Assurance (NCQA) is a nonprofit organization that accredits health plans and other healthcare organizations. Under the current NCQA accreditation program, a health plan's accreditation score is determined, in part, by

  A. is a performance-measurement tool designed to help healthcare purchasers and consumers compare quality offered by different plans.
  B. divides performance measures into 8 domains, and organizes reporting measures under these domains.
  C. is updated annually and measures are changed or new measures added.
  D. all of the above
  D. all of the above

• Question 222:

  What are the characteristics that the underwriter has to consider while determining the premium rate for health insurance coverage for a group?

  A. Level of benefits
  B. Geographic location
  C. Group size
  D. All the above
  D. All the above

• Question 223:

  Health plans often program into their claims processing systems certain criteria that, if unmet, will prompt further investigation of a claim. In an automated claims processing system, these criteria may signal the need for further review when, for example

  A. Encounter reports
  B. Diagnostic codes
  C. Durational ratings
  D. Edits
  D. Edits

• Question 224:

  Types of alternative care centers include urgent care centers, observation care units, and stepdown units. One difference between the costs associated with alternative care centers is that, compared to the cost of:

  A. Facilities, equipment, and staffing in hospital emergency departments (EDs), the cost of facilities, equipment, and staffing in observation care units is generally lower
  B. Care delivered in urgent care centers, the cost of care delivered in hospital emergency departments (EDs) is generally lower.
  C. Care in step-down units, the cost of acute inpatient care is generally lower.
  D. Primary care in a physician's office, the cost of care delivered in urgent care centers is generally lower.
  A. Facilities, equipment, and staffing in hospital emergency departments (EDs), the cost of facilities, equipment, and staffing in observation care units is generally lower

• Question 225:

  The following statements describe two types, or models, of HMOs:

  The Quest HMO has contracted with only one multi-specialty group of physicians. These physicians are employees of the group practice, have an equity interest in the practice, and provide

  A. A captive group a staff model
  B. A captive group a network model
  C. An independent group a network model
  D. An independent group a staff model
  B. A captive group a network model

• Question 226:

  An HMO's quality assurance program must include

  A. A statement of the HMO's goals and objectives for evaluating and improving enrollees' health status
  B. Documentation of all quality assurance activities
  C. System for periodically reporting program results to the HMO's board of directors, its providers, and regulators
  D. All the above
  D. All the above

• Question 227:

  The application of health plan principles to workers' compensation insurance programs has presented some unique challenges because of the differences between health plan for traditional group healthcare and workers' compensation. One key difference is that

  A. limits coverage to eligible employees and excludes part-time employees
  B. specifies an annual lifetime benefit maximum on dollar coverage for medical costs
  C. provides benefits regardless of the cause of an injury or illness
  D. provides benefits for both healthcare costs and lost wages
  D. provides benefits for both healthcare costs and lost wages

• Question 228:

  Following a report by the Institute of Medicine on the incidence and consequences of medical errors, a national task force recommended implementation of a nationwide mandatory system of collecting, analyzing, and reporting standardized information about m

  A. random change
  B. structural change
  C. haphazard change
  D. reactive change
  D. reactive change

• Question 229:

  Bill the member for the balance of the fee above the maximum allowable amount under the fee schedule reimbursement method

  A. UCR fee
  B. Capitation fee
  C. Balance bill
  D. Discounted fee-for-service
  C. Balance bill

• Question 230:

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