AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 261:

  From the following answer choices, choose the description of the ethical principle that best corresponds to the term Autonomy

  A. Health plans and their providers are obligated not to harm their members
  B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group
  C. Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members
  D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives
  D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives

• Question 262:

  Which of the following features differentiates a 'Clinic without walls1 from a consolidated medical group?

  A. Unlike a consolidated medical group, physicians in a 'Clinic without walls' maintain their practices independently in multiple locations.
  B. Unlike a consolidated medical group, a 'Clinic without walls' performs or arranges for business operations for the member physicians.
  C. Both A and B
  A. Unlike a consolidated medical group, physicians in a 'Clinic without walls' maintain their practices independently in multiple locations.

• Question 263:

  System classifies hundreds of hospital services based on a number of criteria, such as primary and secondary diagnosis, surgical procedures, age, gender, and the presence of complications.

  A. Carve-out
  B. DRG
  C. Global capitation
  D. Partial capitation
  B. DRG

• Question 264:

  Before the Leo 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. receive compensation based on the volume and variety for medical services they perform for Leo plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services
  B. have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy
  C. receive from the IPA the same monthly compensation for each Leo plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees
  D. receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges
  C. receive from the IPA the same monthly compensation for each Leo plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees

• Question 265:

  The Clover Group is a for-profit MCO that operates in the United States. The Valentine Group owns all of Clover's stock. The Valentine Group's sole business is the ownership of controlling interests in the shares of other companies. This information indic

  A. holding company of the Valentine Group
  B. sister corporation of the Valentine Group
  C. parent company of the Valentine Group
  D. subsidiary of the Valentine Group
  D. subsidiary of the Valentine Group

• Question 266:

  Primary care case managers (PCCMs) provide managed healthcare services to eligible Medicaid recipients. With regard to PCCMs, it is correct to say that

  A. PCCMs contract directly with the federal government to provide case management services to Medicaid recipients
  B. all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs
  C. Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards
  D. PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients
  C. Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

• Question 267:

  Although the process is voluntary for health plans, external accreditation is becoming more and more important as states and purchasers require health plans undergo as many states and purchasers require health plans undergo some type of external review pr

  A. Is voluntary for health plans.
  B. Requires all change accreditation organizations to use the same standards of accreditation.
  C. Typically requires the accrediting organization to conduct a medical record review and a review of a health plan's credentialing processes, but not an evaluation of the health plans' member service systems processes.
  D. Cannot assure that a health plan meets a specified level of quality.
  A. Is voluntary for health plans.

• Question 268:

  The process of identifying and classifying the risk represented by an individual or group is called

  A. Rating
  B. Anti selection
  C. Underwriting
  D. None of the above
  C. Underwriting

• Question 269:

  In order to measure the expenses of institutional utilization, Holt Healthcare Group uses the standard formula to calculate hospital bed days per 1,000 plan members per year. On October 23, Holt used the following information to calculate the bed days per

  A. 278
  B. 397
  C. 403
  D. 920
  B. 397

• Question 270:

  To determine fee reimbursements to be paid to physicians, the Triangle Health Plan assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier. Triangle and the providers negotiate the value of the

  A. diagnosis-related group (DRG) system
  B. relative value scale (RVS)
  C. partial capitation arrangement
  D. capped fee system
  B. relative value scale (RVS)