AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 311:

  The following statements are about the non-group market for managed care products in the United States. Select the answer choice containing the correct statement.

  A. In order to promote a product to the individual market, MCOs typically rely on personal selling by captive agents rather than on promotional tools such as direct mail, telemarketing, and advertising.
  B. Managed Medicare plans typically are allowed to reject a Medicare applicant on the basis of the results of medical underwriting of the applicant.
  C. HCFA (now known as the Centers for Medicare and Medicaid Services) must approve all membership and enrollment materials used by MCOs to market managed care products to the Medicare population.
  D. Managed care plans are not allowed to health screen individual market customers who are under age 65, even if the health screen could help prevent anti selection.
  C. HCFA (now known as the Centers for Medicare and Medicaid Services) must approve all membership and enrollment materials used by MCOs to market managed care products to the Medicare population.

• Question 312:

  Which of the following population groups are eligible for Medicare coverage

  A. Individuals aged 65 and above, regardless of income and medical history
  B. Individuals suffering from end stage renal disease, regardless of age
  C. Individuals aged 50 or above suffering from qualifying disabilities
  D. Both A and B
  D. Both A and B

• Question 313:

  Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

  A. Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.
  B. Health plans are never allowed to medically underwrite individual market customers who are under age 65.
  C. To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.
  D. Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.
  A. Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.

• Question 314:

  Graff Scott is a member of the ABC Health Plan. Whenever she needs non-emergency medical care, sees Dr. Michael Chan, an internist. Ms. Scott cannot self-refer to a specialist, so she saw Dr. Michael Chan when she experienced headaches. Dr. Michael Chan referred her to Dr. Bruce Lee, a neurologist, who had hospitalized at the Polo Hospital for tests. ABC has contracts with Dr. Michael Chan, Dr. Lee, and Polo to provide medical services to its members. The following statements are about Polo's organized system of healthcare. Select the answer choice containing the correct statement

  A. Within Polo's system, Ms. Scott received primary care from both Dr. Michael Chan and Dr. Lee
  B. Polo's system allows its members open access to all of Ultra's participating providers
  C. Polo's network of providers includes Dr. Michael Chan and Dr. Lee but not Polo Hospital
  D. Within Polo's system, Dr. Michael Chan serves as a coordinator of care or gatekeeper for the medical services that Ms. Scott receives
  D. Within Polo's system, Dr. Michael Chan serves as a coordinator of care or gatekeeper for the medical services that Ms. Scott receives

• Question 315:

  The following statements apply to flexible spending arrangements. Select the answer choice that contains the correct statement.

  A. FSAs were designed to help increase health insurance coverage among self-employed individuals.
  B. Only employers may contribute funds to FSAs.
  C. The popularity of FSAs has been limited because funds may not be rolled over from year to year.
  D. A popular feature of FSAs is their portability, which allows employees to take the funds with them when they change jobs.
  C. The popularity of FSAs has been limited because funds may not be rolled over from year to year.

• Question 316:

  In Order to act as a TPA an organization must

  A. Establish written procedures for adverse determinations and appeals
  B. Obtain a certificate of authority from the state insurance department
  C. Designating the organization as a TPA
  D. All of the above
  B. Obtain a certificate of authority from the state insurance department

• Question 317:

  Lansdale Healthcare, a health plan, offers comprehensive healthcare coverage to its members through a network of physicians, hospitals, and other service providers. Plan members who use in-network services pay a copayment for these services. The copayment

  A. specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered
  B. percentage of the fees for medical services that a plan member must pay after Magellan has paid its share of the costs of those services
  C. flat amount that a plan member must pay each year before Magellan will make any benefit payments on behalf of the plan member
  D. specified payment for services that was negotiated between the provider and Magellan
  A. specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered

• Question 318:

  The Cleopatra Group, a third-party administrator (TPA), has entered into a TPA agreement with the Alexander MCO with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. On

  A. hold all funds it receives on behalf of Alexander in trust
  B. assume full responsibility for determining the claim payment procedures for the plan
  C. assume full responsibility for ensuring that the health plan is administered properly
  D. obtain from the federal government a certificate of authority designating the Cleopatra Group as a TPA
  A. hold all funds it receives on behalf of Alexander in trust

• Question 319:

  The Robust Health Plan sometimes uses prospective experience rating to calculate the premiums for a group. Under prospective experience rating, Robust most likely will:

  A. At the end of a rating period, the financial gains and losses experienced by the group during that rating period and, if the group's experience during the period is better than expected, refund part of the group's premium in the form of an experience ratio
  B. Use Robust's average experience with all groups to calculate this particular group's premium.
  C. Use the group's past experience to estimate the group's expected experience for the next period.
  D. All of the above
  C. Use the group's past experience to estimate the group's expected experience for the next period.

• Question 320:

  The following programs are part of the Alcove MCO's utilization management (UM) program:

  A telephone triage program Preventive care initiatives A shared decision-making program A self-care program

  With regard to the UM programs, it is most likely cor

  A. self-care program is intended to complement physicians' services, rather than to supercede or eliminate these services
  B. telephone triage program is staffed by physicians only
  C. shared decision-making program is appropriate for virtually any medical condition
  D. preventive care initiatives include immunization programs but not health promotion programs
  A. self-care program is intended to complement physicians' services, rather than to supercede or eliminate these services