AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 31:

  By definition, a health plan's network refers to the

  A. organizations and individuals involved in the consumption of healthcare provided by the plan
  B. relative accessibility of the plan's providers to the plan's participants
  C. group of physicians, hospitals, and other medical care providers with whom the plan has contracted to deliver medical services to its members
  D. integration of the plan's participants with the plan's providers
  C. group of physicians, hospitals, and other medical care providers with whom the plan has contracted to deliver medical services to its members

• Question 32:

  If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

  A. A Level One appeal, and the member has the right to a further appeal
  B. A Level Two appeal, and the reviewer's decision is final and binding
  C. An independent external appeal, and the member has the right to a further appeal
  D. Arbitration, and the reviewer's decision is final and binding
  A. A Level One appeal, and the member has the right to a further appeal

• Question 33:

  Natalie Chan is a member of the Ultra Health Plan. Whenever she needs non-emergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a specialist, so she saw Dr. Craig when she experienced headaches. Dr. Craig referred

  A. Within Ultra's system, Ms. Chan received primary care from both Dr. Craig and Dr. Lee.
  B. Ultra's system allows its members open access to all of Ultra's participating providers.
  C. Within Ultra's system, Dr. Craig serves as a coordinator of care or gatekeeper for the medical services that Ms. Chan receives.
  D. Ultra's network of providers includes Dr. Craig and Dr. Lee but not Arrow Hospital.
  C. Within Ultra's system, Dr. Craig serves as a coordinator of care or gatekeeper for the medical services that Ms. Chan receives.

• Question 34:

  The following statements apply to Archer medical savings accounts. Select the answer choice that contains the correct statement.

  A. MSAs were established as a demonstration project under the Medicare Modernization Act.
  B. MSAs were seen as an improvement over FSAs because they are portable, allowing employees to take the funds with them when they change jobs.
  C. The popularity of MSAs has been limited because funds may not be rolled over from year to year.
  D. MSAs are one of the fastest growing Types of Consumer-Directed Health Plans.
  B. MSAs were seen as an improvement over FSAs because they are portable, allowing employees to take the funds with them when they change jobs.

• Question 35:

  The health plan determines what it considers to be the acceptable fee for a service or procedure and the physician agrees to accept that amount as payment in full for the procedure

  A. Usual, Customary, and Reasonable fee
  B. Discounted FFS
  C. Fee Maximum
  D. Relative Value Scale
  B. Discounted FFS

• Question 36:

  The following statements are about accreditation in health plans. Select the answer choice that contains the correct statement.

  A. Accreditation is typically performed by a panel of physicians and administrators employed by the health plan under evaluation.
  B. All accrediting organizations use the same standards of accreditation.
  C. Results of accreditation evaluations are provided only to state regulatory agencies and are not made available to the general public.
  D. Accreditation demonstrates to an health plan's external customers that the plan meets established standards for quality care.
  D. Accreditation demonstrates to an health plan's external customers that the plan meets established standards for quality care.

• Question 37:

  The participating physicians remain independent practitioners who operate out of their own offices and can treat other patients in addition to Kayak plan members. Kayak can correctly be characterized as

  A. a closed-panel HMO
  B. an open-panel HMO
  C. a direct contract model HMO
  D. a dual choice HMO
  B. an open-panel HMO

• Question 38:

  Primary care case managers (PCCMs) provide case management services to eligible Medicaid recipients. With regard to PCCMs it is correct to say that:

  A. PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients.
  B. All Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs.
  C. PCCMs receive a case management fee in addition to reimbursement for medical services on a FFS basis.
  D. PCCMs contract directly with the federal government to provide case management services to Medicaid recipients.
  C. PCCMs receive a case management fee in addition to reimbursement for medical services on a FFS basis.

• Question 39:

  The measures used to evaluate healthcare quality are generally divided into three categories: process, structure and outcomes. An example of a process measure that can be used to evaluate an MCO's performance is the

  A. percentage of board certified physicians within the MCO's network
  B. number of hospital admissions for plan members with certain medical conditions
  C. number of plan members contracting an infection in the hospital
  D. percentage of adult plan members who receive regular medical checkups
  D. percentage of adult plan members who receive regular medical checkups

• Question 40:

  In most cases, medical errors are caused by breakdowns in the healthcare system rather than by provider mistakes.

  A. True
  B. False
  A. True