AHIP AHIP Certification AHM-250 Questions & Answers

• Question 31:

  The National Committee for Quality Assurance (NCQA) is a nonprofit organization that accredits health plans and other healthcare organizations. Under the current NCQA accreditation program, a health plan's accreditation score is determined, in part, by

  A. is a performance-measurement tool designed to help healthcare purchasers and consumers compare quality offered by different plans.

  B. divides performance measures into 8 domains, and organizes reporting measures under these domains.

  C. is updated annually and measures are changed or new measures added.

  D. all of the above

  Correct Answer: D

• Question 32:

  The following statement(s) can correctly be made about Medicaid managed care plans:

  A. A state may mandate health plan enrollment if it offers enrollees in non-rural areas a choice of at least two health plans and offers rural enrollees a choice of at lea

  B. Both A and B

  C. A only

  D. B only

  E. Neither A nor B

  Correct Answer: A

• Question 33:

  Which out of the three is accomplished through precertification?

  A. Concurrent review

  B. Retrospective review

  C. Prospective review

  Correct Answer: C

• Question 34:

  System classifies hundreds of hospital services based on a number of criteria, such as primary and secondary diagnosis, surgical procedures, age, gender, and the presence of complications.

  A. Carve-out

  B. DRG

  C. Global capitation

  D. Partial capitation

  Correct Answer: B

• Question 35:

  Which of the following population groups are eligible for Medicare coverage

  A. Individuals aged 65 and above, regardless of income and medical history

  B. Individuals suffering from end stage renal disease, regardless of age

  C. Individuals aged 50 or above suffering from qualifying disabilities

  D. Both A and B

  Correct Answer: D

• Question 36:

  Abbreviation for JCAHO is

  A. Joint Coordination on Accreditation of Healthcare Organizations

  B. Joint Commission on Accreditation of Healthcare Organizations

  C. Joint Corporation on Accreditation of Healthcare Organizations

  D. Joint Connection on Accreditation of Healthcare Organizations

  Correct Answer: B

• Question 37:

  The Neptune Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot afford to pay for the care by themselves or who receive services at reduced rates because they are covered under govern me

  A. cost shifting

  B. Anti selection

  C. receivership

  D. Underwriting

  Correct Answer: A

• Question 38:

  The contract between an employer and an insurer or other TPA is called

  A. Claims

  B. Bond

  C. ASO

  D. None of the above

  Correct Answer: C

• Question 39:

  Which of the following best describes an organization that is owned by a hospital or group of investors and provides management and administrative support services to individual physicians or small group practices?

  A. Independent Practice Association (IPA).

  B. Group Practice Without Walls (GPWW)

  C. Management Services Organization (MSO).

  D. Consolidated Medical Group.

  Correct Answer: C

• Question 40:

  Two MCOs in a single service area divided purchasers into two groups and agreed to each market their products to only one purchaser group. This information indicates that these two MCOs violated antitrust requirements because they engaged in an activity key

  A. horizontal group boycott

  B. horizontal division of markets

  C. a tying arrangement

  D. price fixing

  Correct Answer: B