AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 331:

  PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, to

  A. fee-for-service arrangement
  B. risk sharing contract
  C. capitation contract
  D. rebate contract
  B. risk sharing contract

• Question 332:

  Each of the following statements describes a health plan that is using a method of managing institutional utilization. Select the answer choice that describes a health plan's use of retrospective review to decrease utilization of hospital services.

  A. The Serenity Healthcare Organization requires a plan member or the provider in charge of the member's care to obtain authorization for inpatient care before the member is admitted to the hospital.
  B. UR nurses employed by the Friendship Health Plan monitor length of stay to identify factors that might contribute to unnecessary hospital days.
  C. The Optimum Health Group evaluates the medical necessity and appropriateness of proposed services and intervenes, if necessary, to redirect care to a more appropriate care setting.
  D. The Axis Medical Group examines provider practice patterns to identify areas in which services are being underused, overused, or misused and designs strategies to prevent inappropriate utilization in the future.
  D. The Axis Medical Group examines provider practice patterns to identify areas in which services are being underused, overused, or misused and designs strategies to prevent inappropriate utilization in the future.

• Question 333:

  In the United States, the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the TRICARE health plan. One true statement about TRICARE is that

  A. hospitals participating in TRICARE program are exempt from JCAHO accreditation and Medicare certification
  B. TRICARE enrollees are not entitled to appeal authorization coverage decisions
  C. active duty personnel are automatically considered enrolled in TRICARE Prime
  D. TRICARE covers inpatient and outpatient services, physician and hospital charges, and medical supplies, but not mental health services
  C. active duty personnel are automatically considered enrolled in TRICARE Prime

• Question 334:

  From the answer choices below, select the response that correctly identifies the rating method that Mr. Sybex used and the premium rate PMPM that Mr. Sybex calculated for the Koster group.

  A. Rating Method book rating Premium Rate PMPM $132
  B. Rating Method book rating Premium Rate PMPM $138
  C. Rating Method blended rating Premium Rate PMPM $132
  D. Rating Method blended rating Premium Rate PMPM $138
  C. Rating Method blended rating Premium Rate PMPM $132

• Question 335:

  Renewal underwriting involves a reevaluation of

  A. The group's experience
  B. Level of participation in the health plan
  C. Both A and B
  D. None of the Above
  C. Both A and B

• Question 336:

  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.
  C. Health club memberships.

• Question 337:

  Ed Murray is a claims analyst for a managed care plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Whenever Mr. Murray receives a health claim from a plan member, he reviews the claim

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

• Question 338:

  One way in which a health plan can support an ethical environment is by

  A. requiring organizations with which it contracts to adopt the plan's formal ethical policy
  B. developing and maintaining a culture where ethical considerations are integrated into decision making at the top organizational level only
  C. establishing a formal method of managing ethical conflicts, such as using an ethics task force or bioethics consultant
  D. maintaining control of policy development by removing providers and members from the process of developing and implementing policies and procedures that provide guidance to providers and members confronted with ethical issues
  C. establishing a formal method of managing ethical conflicts, such as using an ethics task force or bioethics consultant

• Question 339:

  The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. Advances in computer technology have revolutionized the processing of medical and drug claims. Claims processing i

  A. Lower
  B. Higher
  C. Same
  D. No change
  B. Higher

• Question 340:

  The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.

  According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

  A. $60
  B. $80
  C. $120
  D. $160
  B. $80