AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 251:

  Medicare Part C can be delivered by the following Medicare Advantage plans:

  A. HCCP, HMO, PPO (local or regional), PFFS or MSA.

  B. CCPs, PFFS or MSA.

  C. HMO, HSA, PPO (local or regional), PFFS or MSA.

  D. HMO, PPO (local or regional), POS, or MSA.

  Correct Answer: B

• Question 252:

  Marlee Whitcomb was covered as a dependent under the group health plan provided by her father's employer. That health plan complied with the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986. When Ms. Whitcomb married, she c

  A. can continue her group coverage for a period not to exceed 48 months

  B. can continue her group coverage for a period not to exceed 36 months

  C. cannot continue her group coverage, but has the right to convert the group coverage to an individual health plan

  D. can continue her group coverage indefinitely

  Correct Answer: B

• Question 253:

  Phillip Tsai is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of

  A. $0

  B. $300

  C. $400

  D. $900

  Correct Answer: C

• Question 254:

  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

  Correct Answer: B

• Question 255:

  One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

  A. A contract management system

  B. A credentialing system

  C. A legacy system

  D. An interoperable communication system

  Correct Answer: A

• Question 256:

  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

  Correct Answer: B

• Question 257:

  Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

  A. Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.

  B. Health plans are never allowed to medically underwrite individual market customers who are under age

  65.

  C. To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.

  D. Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.

  Correct Answer: A

• Question 258:

  The following sentence contains an incomplete statement with two missing words. Select the answer choice that contains the words that correctly fill in the missing blanks.

  At its core, consumer choice involves empowering healthcare consumers to play a __

  A. greater/lesser

  B. greater/greater

  C. lesser/greater

  D. lesser/lesser

  Correct Answer: B

• Question 259:

  The following organizations are the primary sources of accreditation of healthcare organizations:

  A. National Committee for Quality Assurance (NCQA)

  B. American Accreditation HealthCare Commission/URAC Of these organizations, performance data is included

  A. A only

  B. B only

  C. A and B

  D. none of the above

  Correct Answer: A

• Question 260:

  Specialty services with certain characteristics tend to make good candidates for health plan approaches. One characteristic used to identify a specialty service that may be a good candidate for a health plan approach is that the service should have

  A. a defined patient population

  B. a complex benefit structure

  C. low, stable costs

  D. appropriate utilization rates

  Correct Answer: A