AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 261:

  One feature of the Employee Retirement Income Security Act (ERISA) is that it:

  A. Requires self-funded employee benefit plans to pay premium taxes at the state level.

  B. Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.

  C. Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.

  D. Requires that state insurance laws apply to all employee benefit plans except insured plans.

  Correct Answer: B

• Question 262:

  More procedures or services may be fully covered within the PPO network than those out of network.

  A. True

  B. False

  Correct Answer: A

• Question 263:

  One factor the Sandpiper Health Plan uses to assess its quality is a clinician's bedside manner, i.e., how friendly and understanding the clinician is, whether the patient feels that the clinician listens to the patient's concerns, how well the clinical

  A. a provider service quality issue

  B. an administrative service quality issue a healthcare process quality issue

  C. a healthcare outcomes quality issue

  D. a healthcare process quality issue

  Correct Answer: A

• Question 264:

  Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

  A. an integrated delivery system (IDS)

  B. a Management Services Organization (MSO)

  C. a Physician Practice Management (PPM) company

  D. a physician-hospital organization (PHO)

  Correct Answer: A

• Question 265:

  One true statement about community rating, a rating method commonly used by health plans, is that:

  A. It requires a health plan to set premiums for financing medical care according to the health plan's expected cost of providing medical benefits to a sub-group within the community.

  B. A health plan usually uses community rating to set premiums for large groups.

  C. It tends to lead to greater fluctuations in premium rates than do other rating methods.

  D. A health plan seldom uses community rating to set premiums for large groups.

  Correct Answer: D

• Question 266:

  The Courtland PPO maintains computerized records that include clinical, demographic, and administrative data about individual plan members. The data in these records is available to plan providers, ancillary service departments, pharmacies, and others inv

  A. a data warehouse

  B. a decision support system

  C. an outsourcing system

  D. an electronic medical record (EMR) system

  Correct Answer: D

• Question 267:

  Specialty services that have certain characteristics generally are good candidates for managed care approaches. These characteristics generally include that the specialty service should have

  A. appropriate, rather than inappropriate, utilization

  B. a defined patient population

  C. low, stable costs

  D. a benefit that cannot be easily defined

  Correct Answer: B

• Question 268:

  Greentree Medical, a health plan, is currently recruiting PCPs in preparation for its expansion into a new service area. Abigail Davis, a recruiter for Greentree, has been meeting with Melissa Cortelyou, M.D., in an effort to recruit her as a PCP in Green

  A. Greentree is prevented by law from offering a contract to Dr. Cortelyou until the credentialing process is complete

  B. any contract signed by Dr. Cortelyou should include a clause requiring the successful completion of the credentialing process within a defined time frame in order for the contract to be effective

  C. Greentree must offer a standard contract to Dr. Cortelyou, without regard to the outcome of the credentialing process

  D. Greentree will abandon the credentialing process now that Dr. Cortelyou has agreed to participate in Greentree's network

  Correct Answer: B

• Question 269:

  An HMO that combines characteristics of two or more HMO models is sometimes referred to as a

  A. Network model HMO

  B. Group model HMO

  C. Staff model HMO

  D. Mixed model HMO

  Correct Answer: D

• Question 270:

  From the answer choices below, select the response that correctly identifies the rating method that Mr. Sybex used and the premium rate PMPM that Mr. Sybex calculated for the Koster group.

  A. Rating Method book rating Premium Rate PMPM $132

  B. Rating Method book rating Premium Rate PMPM $138

  C. Rating Method blended rating Premium Rate PMPM $132

  D. Rating Method blended rating Premium Rate PMPM $138

  Correct Answer: C