AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 301:

  The measures used to evaluate healthcare quality are generally divided into three categories: process, structure, and outcomes. An example of a process measure that can be used to evaluate a health plan's performance is the:

  A. Percentage of adult plan members who receive regular medical checkups.
  B. Number of plan members contracting an infection in the hospital.
  C. Percentage of board certified physicians within the health plan's network.
  D. Number of hospital admissions for plan members with certain medical conditions.
  A. Percentage of adult plan members who receive regular medical checkups.

• Question 302:

  One ethical principle in health plans is the principle of non-malfeasance, which holds that health plans and their providers:

  A. Should allocate resources in a way that fairly distributes benefits and burdens among the members.
  B. Have a duty to present information honestly and are obligated to honor commitments.
  C. Are obligated not to harm their members.
  D. Should treat each plan member in a manner that respects his or her goals and values.
  C. Are obligated not to harm their members.

• Question 303:

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

• Question 304:

  The following statement(s) can correctly be made about Medicaid managed care plans:

  A. A state may mandate health plan enrollment if it offers enrollees in non-rural areas a choice of at least two health plans and offers rural enrollees a choice of at lea
  B. Both A and B
  C. A only
  D. B only
  E. Neither A nor B
  A. A state may mandate health plan enrollment if it offers enrollees in non-rural areas a choice of at least two health plans and offers rural enrollees a choice of at lea

• Question 305:

  Emily Brown works for Integral Health Plan and represents the company as a board member for the board of directors. Which best describes Emily's position?

  A. Community Representative
  B. Inside Director
  C. Outside Director
  D. None of these
  B. Inside Director

• Question 306:

  The main advantage of using outcomes measures to evaluate healthcare quality is that they Typically

  A. are easy to identify and report
  B. demonstrate improved clinical and functional status over time
  C. are insensitive to changes in structures or processes
  D. provide meaningful feedback on care delivery even when the delay between treatment and outcome stretches over several years
  B. demonstrate improved clinical and functional status over time

• Question 307:

  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
  A. Both A and B

• Question 308:

  The Mosaic health plan uses a typical electronic medical record (EMR) to document the medical care its members receive. One characteristic of Mosaic's EMR is that it:

  A. Does not provide any clinical decision support for Mosaic's providers.
  B. Is designed to supply information at the site of care.
  C. Contains a Mosaic member's clinical data only.
  D. Is organized by the type of treatment or by provider.
  B. Is designed to supply information at the site of care.

• Question 309:

  Al Marak, a member of the Frazier Health Plan, has asked for a typical Level One appeal of a decision that Frazier made regarding Mr. Marak's coverage. One true statement about this Level One appeal is that

  A. Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision
  B. It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute
  C. It is considered to be an informal appeal
  D. It will be handled by an independent review organization (IRO)
  A. Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision

• Question 310:

  Utilization review offers health plans a means of managing costs by managing

  A. Cost effectiveness of healthcare services.
  B. Cost of paying healthcare benefits.
  C. Both of the above
  C. Both of the above