AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 271:

  Health savings accounts were created by which of the following laws:

  A. COBRA

  B. HIPAA

  C. Medicare Modernization Act

  D. None of the Above

  Correct Answer: C

• Question 272:

  Consumer-directed health plans are not a new concept. They actually got their start in the late 1970s with the advent of:

  A. Health savings accounts (HSAs)

  B. Health reimbursement arrangements (HRAs)

  C. Medical savings accounts (MSAs)

  D. Flexible spending arrangements (FSAs)

  Correct Answer: D

• Question 273:

  A medical foundation is a not-for-profit entity that purchases and manages physician practices. In order to retain its not-for-profit status, a medical foundation must

  A. Provide significant benefit to the community

  B. Employ, rather than contract with, participating physicians

  C. Achieve economies of scale through facility consolidation and practice management

  D. Refrain from the corporate practice of medicine

  Correct Answer: A

• Question 274:

  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. Receive compensation based on the volume and variety of medical services they perform for Hill 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 Hill 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.

  Correct Answer: C

• Question 275:

  In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care.

  A. Such intervention can be based on the results of

  B. Prospective review

  C. Concurrent review

  A. A, B, and C

  B. A and B only

  C. A and C only

  D. B only

  Correct Answer: D

• Question 276:

  An exclusive provider organization (EPO) operates much like a PPO. However, one difference between an EPO and a PPO is that an EPO

  A. Is regulated under federal HMO legislation

  B. Generally provides no benefits for out-of-network care

  C. Has no provider network of physicians

  D. Is not subject to state insurance laws

  Correct Answer: B

• Question 277:

  Because many patients with behavioral health disorders do not require round-the-clock nursing care and supervision, behavioral healthcare services can be delivered effectively in a variety of settings. For example, post-acute care for behavioral health di

  A. Hospital observation units or psychiatric hospitals.

  B. Psychiatric hospitals or rehabilitation hospitals.

  C. Subacute care facilities or skilled nursing facilities.

  D. Psychiatric units in general hospitals or hospital observation units.

  Correct Answer: C

• Question 278:

  In health plan terminology, demand management, as used by health plans, can best be described as

  A. an evaluation of the medical necessity, efficiency, and/or appropriateness of healthcare services and treatment plans for a given patient

  B. a series of strategies designed to reduce plan members' needs to utilize healthcare services by encouraging preventive care, wellness, member self-care, and appropriate use of healthcare services

  C. a technique that prevents a provider who is being reimbursed under a fee schedule arrangement from billing a plan member for any fees that exceed the maximum fee reimbursed by the plan

  D. a system of identifying plan members with special healthcare needs, developing a healthcare strategy to meet those needs, and coordinating and monitoring the care

  Correct Answer: B

• Question 279:

  For this question, select the answer choice containing the terms that correctly complete the blanks labeled A and B in the paragraph below.

  NCQA offers Quality Compass, a national database of performance and accreditation information submitted by managed

  A. Health Plan Employer Data and Information Set (HEDIS) mandatory

  B. Health Plan Employer Data and Information Set (HEDIS) voluntary

  C. ORYX mandatory

  D. ORYX voluntary

  Correct Answer: B

• Question 280:

  In most cases, medical errors are caused by breakdowns in the healthcare system rather than by provider mistakes.

  A. True

  B. False

  Correct Answer: A