AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 341:

  In large health plans, management functions such as provider recruiting, credentialing, contracting, provider service, and performance management for providers are typically the responsibility of the

  A. chief executive officer (CEO)

  B. network management director

  C. board of directors

  D. director of operations

  Correct Answer: B

• Question 342:

  Federal Employee Health Benefits Program (FEHBP) requires health plans offering services to federal employees and their dependents to provide

  A. Immediate access to emergency services

  B. Urgent Appointments within 24 hours

  C. Routine appointments once a m

  D. D

  E. A

  F. B and C

  G. All of the listed options

  Correct Answer: F

• Question 343:

  A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

  A. the specialists in the PHO are typically compensated on a capitation basis

  B. the specialists in the PHO are typically compensated on a capitation basis

  C. it typically limits the number of specialists by type of specialty

  D. it is available to a hospital's entire eligible medical staff

  E. physician membership in the PHO is limited to PCPs

  Correct Answer: B

• Question 344:

  Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billi

  A. prevent Dr. Ware from requiring a Riverside member to pay any coinsurance, copayment, or deductibles that the member would normally pay under Riverside's plan

  B. require Dr. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts

  C. prevent Dr. Ware from seeking compensation from patients if Riverside fails to compensate him because of the MCO's insolvency

  D. prevent Dr. Ware from billing a Riverside member for medical services that are not included in Riverside's plan

  Correct Answer: B

• Question 345:

  Before an HMO contracts with a physician, the HMO first verifies the physician's credentials.

  Upon becoming part of the HMO's organized system of healthcare, the physician is typically subject to

  A. both recredentialing and peer review

  B. recredentialing only

  C. peer review only

  D. neither recredentialing nor peer review

  Correct Answer: C

• Question 346:

  For providers, integration occurs when two or more previously separate providers combine under common ownership or control, or when two or more providers combine business operations that they previously carried out separately and independently. Such provi

  A. higher costs for health plans, healthcare purchasers, and healthcare consumers

  B. improved provider contracting position with health plans

  C. an increase in providers' autonomy and control over their own work environment

  D. all of the above

  Correct Answer: B

• Question 347:

  A public employer, such as a municipality or county government would be considered which of the following?

  A. Employer-employee group

  B. Multiple-employer group

  C. Affinity group

  D. Debtor-creditor group

  Correct Answer: A

• Question 348:

  During an open enrollment period in 1997, Amy Hadek enrolled through her employer for group health coverage with the Owl Health Plan, a federally qualified HMO. At the time of her enrollment, Ms. Hadek had three pre-existing medical conditions: angina, fo

  A. the angina, the high blood pressure, and the broken ankle

  B. the angina and the high blood pressure only

  C. none of these conditions

  D. the broken ankle only

  Correct Answer: A

• Question 349:

  In order to generate exchanges with consumers, healthcare plan marketers use the four elements of the marketing mix: product, price, place (distribution), and

  A. segmentation

  B. publicity

  C. promotion

  D. plan design

  Correct Answer: C

• Question 350:

  In 1999, the United States Congress passed the Financial Services Modernization Act, which is referred to as the Gramm-Leach-Bliley (GLB) Act. The following statement(s) can correctly be made about this act:

  A. The GLB Act allows convergence among the transaction

  B. A only

  C. Both A and B

  D. B only

  E. Neither A nor B

  Correct Answer: B