AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 341:

  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 342:

  Specialty services with certain characteristics tend to make good candidates for health plan approaches. One characteristic used to identify a specialty service that may be a good candidate for a health plan approach is that the service should have

  A. a defined patient population
  B. a complex benefit structure
  C. low, stable costs
  D. appropriate utilization rates
  A. a defined patient population

• Question 343:

  Parable Healthcare Providers, a health plan, recently segmented the market for a new healthcare service. Parable began the process by dividing the healthcare market into two broad categories: non-group and group. Next, Parable further segmented the non-gr

  A. channel segmentation
  B. geographic segmentation
  C. demographic segmentation
  D. product segmentation
  C. demographic segmentation

• Question 344:

  The process that Mr. Sybex used to identify and classify the risk represented by the Koster Group so that Intuitive can charge premiums that are adequate to cover its expected costs is known as

  A. coinsurance
  B. plan funding
  C. underwriting
  D. pooling
  C. underwriting

• Question 345:

  Integration of provider organizations is said to occur when

  A. Previously separate providers combine and come under common ownership or control.
  B. Two or more providers combine their business operations that they previously carried out separately.
  C. Both A and B
  D. None of the above
  C. Both A and B

• Question 346:

  The Employee Retirement Income Security Act (ERISA) requires health plan members who receive healthcare benefits through employee benefit plans to file legal challenges involving coverage decisions or plan administration at the federal level. Under the te

  A. contract damages, which cover the cost of denied treatment
  B. compensatory damages, which compensate the injured party for his or her injuries
  C. punitive damages, which are designed to punish or make an example of the wrongdoer
  D. all of the above
  A. contract damages, which cover the cost of denied treatment

• Question 347:

  The following sentence contains an incomplete statement with two missing words. Select the answer choice that contains the words that correctly fill in the missing blanks. At its core, consumer choice involves empowering healthcare consumers to play a __

  A. greater/lesser
  B. greater/greater
  C. lesser/greater
  D. lesser/lesser
  B. greater/greater

• Question 348:

  One of the most influential pieces of legislation in the advancement of health plans within the United States was the Health Maintenance Organization (HMO) Act of 1973. One of the provisions of the Act was that it

  A. exempted HMOs from all state licensure requirements.
  B. required all employers that offered healthcare coverage to their employees to offer only one type of federally qualified HMO.
  C. eliminated funding that supported the planning and start-up phases of new HMOs.
  D. established a process by which HMOs could obtain federal qualification
  D. established a process by which HMOs could obtain federal qualification

• Question 349:

  One way that MCOs involve providers in risk sharing is by retaining a percentage of the providers' payment during a plan year. At the end of the plan year, the MCO may use the amount retained to offset or pay for any cost overruns for referral or hospital

  A. withholds
  B. usual, customary, and reasonable (UCR) fees
  C. risk pools
  D. per diems
  A. withholds

• Question 350:

  The following organizations are the primary sources of accreditation of healthcare organizations:

  A. A only
  B. B only
  C. A and B
  D. none of the above
  A. A only