AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 331:

  Immediate evaluation and treatment of illness or injury can be provided in any of the following care settings:

  A. Hospital emergency departments

  B. Physician's offices

  C. Urgent care centers

  D. If these settings are ranked in order of the cost of providing c

  A. A, B, C

  B. A, C, B

  C. B, C, A

  D. C, A, B

  Correct Answer: B

• Question 332:

  In order to help review its institutional utilization rates, the Sahalee Medical Group, a health plan, uses the standard formula to calculate hospital bed days per 1,000 plan members for the month to date (MTD). On April 20, Sahalee used the following inf

  A. 67

  B. 274

  C. 365

  D. 1,000

  Correct Answer: B

• Question 333:

  In the following sections, we will describe some of the measures health plans use to evaluate the quality of the services and healthcare they offer their members.

  Which of the following is the best description of what a 'Process measure' evaluates?

  A. The nature, quantity, and quality of the resources that a health plan has available for member service and patient care.

  B. The methods and procedures a health plan and its providers use to furnish service and care.

  C. The extent to which services succeed in improving or maintaining satisfaction and patient health.

  D. None of the above

  Correct Answer: B

• Question 334:

  Following a report by the Institute of Medicine on the incidence and consequences of medical errors, a national task force recommended implementation of a nationwide mandatory system of collecting, analyzing, and reporting standardized information about m

  A. random change

  B. structural change

  C. haphazard change

  D. reactive change

  Correct Answer: D

• Question 335:

  In accounting terminology, the items of value that a company owns--such as cash, cash equivalents, and receivables--are generally known as the company's

  A. revenue

  B. net income

  C. surplus

  D. assets

  Correct Answer: D

• Question 336:

  Although the process is voluntary for health plans, external accreditation is becoming more and more important as states and purchasers require health plans undergo as many states and purchasers require health plans undergo some type of external review pr

  A. Is voluntary for health plans.

  B. Requires all change accreditation organizations to use the same standards of accreditation.

  C. Typically requires the accrediting organization to conduct a medical record review and a review of a health plan's credentialing processes, but not an evaluation of the health plans' member service systems processes.

  D. Cannot assure that a health plan meets a specified level of quality.

  Correct Answer: A

• Question 337:

  Ed O'Brien has both Medicare Part A and Part B coverage. He also has coverage under a PBM plan that uses a closed formulary to manage the cost and use of pharmaceuticals. Recently, Mr. O'Brien was hospitalized for an aneurysm. Later, he was transferred by

  A. Confinement in the extended-care facility after his hospitalization.

  B. Transportation by ambulance from the hospital to the extended-care facility.

  C. Physicians' professional services while he was hospitalized.

  D. physicians' professional services while he was at the extended-care facility.

  Correct Answer: A

• Question 338:

  As part of its utilization management (UM) system, the Poplar MCO uses a process known as case management. The following statements describe individuals who are Poplar plan members:

  Brad Van Note, age 28, is taking many different, costly medications for

  A. Mr. Van Note, Mr. Albrecht, and Ms. Cromartie

  B. Mr. Van Note and Ms. Cromartie only

  C. Mr. Van Note and Mr. Albrecht only

  D. Mr. Albrecht and Ms. Cromartie only

  Correct Answer: C

• Question 339:

  From the following choices, choose the definition that best matches the term Screening

  A. A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

  B. A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

  C. A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific

  illnesses or injuries

  D. A technique used to evaluate the medical necessity, appropriateness, and cost- effectiveness of healthcare services for a given patient

  Correct Answer: B

• Question 340:

  All CDHP products provide federal tax advantages while allowing consumers to save money for their healthcare.

  A. True

  B. False

  Correct Answer: A