AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 281:

  In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

  A. Therapeutic / always

  B. Generic / always

  C. Generic / never

  D. Therapeutic / never

  Correct Answer: A

• Question 282:

  Appropriateness of treatment provided is determined by developing criteria that if unmet will prompt further investigation of a claim which are also called:

  A. Codes

  B. Lists

  C. Edits

  D. Checks

  Correct Answer: C

• Question 283:

  General HMO is building a provider network and is considering Universal Hospital as an addition to its network. Minimum requirements that General should consider in determining whether Universal is qualified to participate in General's network include A.

  A. Both A and B

  B. A only

  C. B only

  D. Neither A nor B

  Correct Answer: A

• Question 284:

  Allgood Medical, Inc., a health plan, has contracted with Mercy Memorial Hospital to provide inpatient medical services to Allgood's plan members. The terms of the contract specify that Allgood will reimburse Mercy Memorial on the basis of a negotiated ch

  A. per diem agreement

  B. fee-for-service agreement

  C. withhold agreement

  D. diagnostic related group (DRG) agreement

  Correct Answer: A

• Question 285:

  A health plan's ability to establish an effective provider network depends on the characteristics of the proposed service area and the needs of proposed plan members. It is generally correct to say that

  A. health plans have more contracting options if providers are affiliated with single entities than if providers are affiliated with multiple entities

  B. urban areas offer more flexibility in provider contracting than do rural areas

  C. consumers and purchasers in markets with little health plan activity are likely to be more receptive to HMOs than to loosely managed plans such as PPOs

  D. large employers tend to adopt health plans more slowly than do small companies

  Correct Answer: B

• Question 286:

  In claims administration terminology, a claims investigation is correctly defined as the process of

  A. reporting management information about services provided each time a patient visits a provider for purposes of analyzing utilization and provider practice patterns

  B. obtaining all the information necessary to determine the appropriate amount to pay on a given claim

  C. routinely reviewing and processing a claim for either payment or denial

  D. assigning to each diagnosis or treatment reported on a claim special codes that briefly and specifically describe each diagnosis and treatment

  Correct Answer: B

• Question 287:

  A health savings account must be coupled with an HDHP that meets federal requirements for minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for inflation. For 2006, the annual deductible for self-only coverage must

  A. $525

  B. $1,050

  C. $2,100

  D. $5,250

  Correct Answer: B

• Question 288:

  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

  Correct Answer: D

• Question 289:

  After a somewhat modest start in 2004, enrollment in HSA-related health plans more than tripled in 2005, making them today's fastest growing type of CDHP. As of January 2006, enrollment in HSAs had reached nearly:

  A. 1.2 million

  B. 2.2 million

  C. 3.2 million

  D. 4.2 million

  Correct Answer: B

• Question 290:

  By definition, a health plan's network refers to the

  A. organizations and individuals involved in the consumption of healthcare provided by the plan

  B. relative accessibility of the plan's providers to the plan's participants

  C. group of physicians, hospitals, and other medical care providers with whom the plan has contracted to deliver medical services to its members

  D. integration of the plan's participants with the plan's providers

  Correct Answer: C