Exam Details

  • Exam Code
    :AHM-250
  • Exam Name
    :Healthcare Management: An Introduction
  • Certification
    :AHIP Certifications
  • Vendor
    :AHIP
  • Total Questions
    :367 Q&As
  • Last Updated
    :Jun 24, 2025

AHIP AHIP Certifications AHM-250 Questions & Answers

  • Question 311:

    Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr. Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

    A. a traditional HMO plan

    B. a managed indemnity plan

    C. a point of service (POS) option

    D. an exclusive provider organization (EPO)

  • Question 312:

    In preparation for its expansion into a new service area, the Regal MCO is meeting with Dr. Nancy Buhner, a cardiologist who practices in Regal's new service area, in order to convince her to become one of the plan's participating providers. As part of the

    A. ensure that Dr. Buhner complies with all of the provisions of the Ethics in Patient Referrals Act

    B. learn whether Dr. Buhner is a licensed medical practitioner

    C. confirm Dr. Buhner's membership in the National Committee for Quality Assurance (NCQA)

    D. learn whether Dr. Buhner has had a medical malpractice claim filed or other disciplinary actions taken against her

  • Question 313:

    Dr. Samuel Aldridge's provider contract with the Badger Health Plan includes a typical due process clause. The primary purpose of this clause is to:

    A. State that Dr. Aldridge's provider contract with Badger will automatically terminate if he loses his medical license or hospital privileges.

    B. Specify a time period during which the party that breaches the provider contract must remedy the problem in order to avoid termination of the contract.

    C. Give Dr. Aldridge the right to appeal Badger's decision if he is terminated with cause from Badger's provider network.

    D. Specify that Badger can terminate this provider contract without providing a reason, but only if Badger gives Dr. Aldridge at least 90-days' notice of its intent to terminate the contract.

  • Question 314:

    If most of the physicians, or many of the physicians in a particular specialty, are affiliated with a single entity, then a health plan building a network in the service area _____________.

    A. Has many contracting options available.

    B. Should not contract with that entity

    C. Most likely needs to contract with that entity

    D. Should attempt to disband the existing affiliations

  • Question 315:

    According to the IRS, which of the following is not an allowable preventive care service?

    A. Smoking cessation programs.

    B. Periodic health examinations.

    C. Health club memberships.

    D. Immunizations for children and adults.

  • Question 316:

    Bart Vereen is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a managed care plan. Both plans have a typical coordination of benefits (COB) provision, but neither plan has a nonduplication of benefits provision

    A. 380

    B. 130

    C. 0

    D. 550

  • Question 317:

    Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

    A. users can access the Internet using a number of different types of computer systems

    B. access to the Internet is available only to members of the health plan's network

    C. the Internet is immune to internal security breaches by employees or trading partners within the network

    D. users can contact a single controlling organization to rectify disruptions in Internet service

  • Question 318:

    Ashley Martin is covered by a managed healthcare plan that specifies a $300 deductible and includes a 30% coinsurance provision for all healthcare obtained outside the plan's network of providers. In 1998, Ms. Martin became ill while she was on vacation,

    A. $300

    B. $510

    C. $600

    D. $810

  • Question 319:

    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)

  • Question 320:

    Beginning in the early 1980s, several factors contributed to increased demand for behavioral healthcare services. These factors included

    A. increased stress on individuals and families

    B. increased availability of behavioral healthcare services

    C. greater awareness and acceptance of behavioral healthcare issues

    D. all of the above

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