AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 251:

  The Gable MCO sometimes experience-rates small groups by underwriting a number of small groups as if they constituted one large group and then evaluating the experience of the entire large group. This practice, which allows small groups to take advantage

  A. prospective experience rating
  B. pooling
  C. retrospective experience rating
  D. positioning
  B. pooling

• Question 252:

  Most contracts between health plans and providers contain a provision which forbids providers from seeking compensation from patients if the health plan fails to compensate the provider because of insolvency or for any other reason. Such a provision is kn

  A. due process provision
  B. cure provision
  C. hold-harmless provision
  D. risk-sharing provision
  C. hold-harmless provision

• Question 253:

  The Internal Revenue Service has ruled that an HDHP coupled with an HSA may cover certain types of preventive care without a deductible or with a lower amount than the annual deductible applicable to all other services. According to IRS guidance, which one

  A. Immunizations for children and adults
  B. Tests and diagnostic procedures ordered with routine examinations
  C. Smoking cessation programs
  D. Gastric bypass surgery for obesity
  D. Gastric bypass surgery for obesity

• Question 254:

  After a somewhat modest start in 2004, enrollment in HSA-related health plans more than tripled in 2005, making them today's fastest growing type of CDHP. As of January 2006, enrollment in HSAs had reached nearly:

  A. 1.2 million
  B. 2.2 million
  C. 3.2 million
  D. 4.2 million
  B. 2.2 million

• Question 255:

  In the following sections, we will describe some of the measures health plans use to evaluate the quality of the services and healthcare they offer their members. Which of the following is the best description of what a 'Process measure' evaluates?

  A. The nature, quantity, and quality of the resources that a health plan has available for member service and patient care.
  B. The methods and procedures a health plan and its providers use to furnish service and care.
  C. The extent to which services succeed in improving or maintaining satisfaction and patient health.
  D. None of the above
  B. The methods and procedures a health plan and its providers use to furnish service and care.

• Question 256:

  IROs stands for

  A. Internal Review Organizations
  B. International review Organizations
  C. Independent review organizations
  D. None of the above
  C. Independent review organizations

• Question 257:

  Which of the following statements is NOT a requirement for a service to be deemed a 'medically necessary service'?

  A. Furnished in the least intensive type of medical care setting required by the member's condition.
  B. Solely for the convenience of the member.
  C. In accordance with the standards of good medical practice.
  D. Consistent with the symptoms of the member's condition.
  B. Solely for the convenience of the member.

• Question 258:

  Which of the following is NOT a preventive care initiative often used by health plans?

  A. Screening for high blood pressure
  B. Maternity management programs
  C. Vaccines
  D. Physical therapy
  D. Physical therapy

• Question 259:

  Beginning in the early 1980s, several factors contributed to increased demand for behavioral healthcare services. These factors included

  A. increased stress on individuals and families
  B. increased availability of behavioral healthcare services
  C. greater awareness and acceptance of behavioral healthcare issues
  D. all of the above
  D. all of the above

• Question 260:

  Before the Hill Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

  A. Hill had to have an initial net worth of at least $1.5 million in order to obtain a COA.
  B. The COA most likely exempts Hill from any of State X's enabling statutes.
  C. Hill had to be organized as a partnership in order to obtain a COA
  D. The COA in no way indicates that Hill has demonstrated that it is fiscally sound.
  A. Hill had to have an initial net worth of at least $1.5 million in order to obtain a COA.