AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 281:

  Eleanor Giambi is covered by a typical 24-hour managed care program. One characteristic of this program is that it:

  A. Provides Ms. Giambi with healthcare coverage for any illness or injury, but only if the cause of the illness or injury is work-related.
  B. Combines the group health plan and disability plan offered by Ms. Giambi's employer with workers' compensation coverage.
  C. Requires Ms. Giambi and her employer to each pay half of the cost of this coverage.
  D. Requires Ms. Giambi to pay specified deductibles and copayments before receiving benefits under this program for any illness or injury.
  B. Combines the group health plan and disability plan offered by Ms. Giambi's employer with workers' compensation coverage.

• Question 282:

  The Neptune Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot afford to pay for the care by themselves or who receive services at reduced rates because they are covered under govern me

  A. cost shifting
  B. Anti selection
  C. receivership
  D. Underwriting
  A. cost shifting

• Question 283:

  The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

  A. $140
  B. $170
  C. $180
  D. $210
  B. $170

• Question 284:

  Amendments to the HMO act 1973 do not permit federally qualified HMO's to use

  A. Retrospective experience rating
  B. Adjusted community rating
  C. Community rating by class
  D. Community rating
  A. Retrospective experience rating

• Question 285:

  Utilization management techniques that most HMOs use for hospital providers include:

  A. Discharge planning
  B. Case management
  C. Co-payment for office visits
  D. A and B
  A. Discharge planning
  B. Case management

• Question 286:

  Exclusive provider organizations (EPO) is similar and operates like a PPO in administration, structure but however in an EPO an out-of-network care is

  A. Partially Covered
  B. Covered with more out of pocket
  C. Not covered
  C. Not covered

• Question 287:

  Katrina Lopez is a claims analyst for a health plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Ms. Lopez reviewed a health claim for answers to the following questions:

  A. A, B, C, and D
  B. A, B, and D only
  C. B, C, and D only
  D. A and C only
  A. A, B, C, and D

• Question 288:

  The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms you have selected. The Harbor Health Plan convened a litigation

  A. a standing / ongoing
  B. a standing / specific
  C. an ad hoc / ongoing
  D. an ad hoc / specific
  D. an ad hoc / specific

• Question 289:

  The Helm MCO segmented the non-group market for its new healthcare product by using factors such as education level, gender, and household composition. The Amberly MCO segmented the non-group market for its products based on the approaches by which it solution

  A. demographic product or benefit
  B. geographic distribution channel
  C. demographic distribution channel
  D. geographic product or benefit
  C. demographic distribution channel

• Question 290:

  The situation wherein two hospitals agree to each refuse to contract with a health plan until the health plan cease contract negotiations with a competing hospital is known as

  A. Horizontal division of markets
  B. Tying arrangements
  C. Horizontal group boycott
  D. Price fixing
  C. Horizontal group boycott