AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 321:

  The following statements describe corporate transactions:

  Transaction A: An MCO acquired another MCO.

  Transaction B: A group of providers formed an organization to carry out billings, collections, and contracting with MCOs for the entire group of provide

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

• Question 322:

  Maternity management programs are commonly included in?

  A. Screening Programs
  B. Health promotion Programs
  C. Immunization programs
  C. Immunization programs

• Question 323:

  The Oriole MCO uses a typical diagnosis-related groups (DRGs) payment method to reimburse the Isle Hospital for its treatment of Oriole members. Under the DRG payment method, whenever an Oriole member is hospitalized at Isle, Oriole pays Islet

  A. an amount based on the weighted value of each medical procedure or service that Isle provides, and the weighted value is determined by the appropriate current procedural terminology (CPT) code for the procedure or service
  B. a fixed rate based on average expected use of hospital resources in a given geographical area for that DRG
  C. a retrospective reimbursement based on the actual costs of the Oriole member's hospitalization
  D. a specific negotiated amount for each day the Oriole member is hospitalized
  B. a fixed rate based on average expected use of hospital resources in a given geographical area for that DRG

• Question 324:

  The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

  A. Credentialing
  B. Accreditation
  C. A sentinel event
  D. A screening program
  A. Credentialing

• Question 325:

  The following statements describe individuals who are applying for individual health insurance coverage: Six months ago, Wilbur Lee lost his health insurance coverage due to a reduction in work hours and has exhausted his coverage under COBRA. Mr. Lee has

  A. both Mr. Lee and Mr. Beeker
  B. Mr. Lee only
  C. Mr. Beeker only
  D. neither Mr. Lee nor Mr. Beeker
  A. both Mr. Lee and Mr. Beeker

• Question 326:

  The Stateside Health Plan uses the following outcomes measures to evaluate the quality of its diabetes disease management program. Measure A: Incidence of foot ulcers among long-term diabetes patients Measure B: Ability of long-term diabetes patients to m

  A. Measure A clinical status Measure B patient perception
  B. Measure A clinical status Measure B functional status
  C. Measure A functional status Measure B patient perception
  D. Measure A functional status Measure B clinical status
  B. Measure A clinical status Measure B functional status

• Question 327:

  Federal legislation has placed the primary responsibility for regulating health insurance companies and HMOs that service private sector (commercial) plan members at the state level.

  This federal legislation is the

  A. Clayton Act
  B. Federal Trade Commission Act
  C. McCarran-Ferguson Act
  D. Sherman Act
  C. McCarran-Ferguson Act

• Question 328:

  Employer-sponsored benefit plans that provide healthcare benefits must comply with the Employee Retirement Income Security Act (ERISA). One of the most significant features of ERISA is that it A. contains a provision stating that the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans

  B. standardizes the conversion of group healthcare benefits to individual healthcare benefits
  C. mandates that self-funded healthcare plans must pay state premium taxes
  D. requires that all active employees, regardless of age, must be eligible for coverage under employer-sponsored benefit plans
  A

• Question 329:

  Historically most HMOs have been

  A. Closed-access HMO
  B. Closed-panel HMO
  C. Open-access HMO
  D. Open-panel HMO
  B. Closed-panel HMO

• Question 330:

  The statements below describe technology used by two health plans to respond to incoming telephone calls:

  The Manor Health Plan uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond t

  A. Manor's system is best described as an automated call distributor (ACD).
  B. Both Manor's system and Squire's device are applications of computer/telephone integration (CTI).
  C. Squire's device is best described as an interactive voice response (IVR) system.
  D. All of these statements are correct.
  B. Both Manor's system and Squire's device are applications of computer/telephone integration (CTI).