AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 41:

  Diabetic patients with high glucose levels requiring stabilization following treatment of an acute attack would best be served in an ___________

  A. Emergency Department
  B. Urgent Care Centre
  C. Hospice Care
  D. Observation Care Unit
  D. Observation Care Unit

• Question 42:

  Several marketplace factors helped fuel the movement toward consumer choice. Which one of the following statements is NOT accurate with regard to these factors?

  A. After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.
  B. During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.
  C. Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.
  D. Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.
  A. After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.

• Question 43:

  Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

  A. Acquisition of the Leopard Health Plan by the Hickory Health Plan.
  B. Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.
  C. Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.
  D. Consolidation of the Carver Health Plan and the Limestone Health Plan.
  C. Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

• Question 44:

  Which of the following statements is true?

  A. A declining economy can lead to lower healthcare costs as a result of an older population with greater healthcare needs.
  B. A larger patient population increases pressure on the health plan to offer larger panels.
  C. Provider networks are not affected by the federal and state laws that apply to health plans
  D. Network management standards established by independent accrediting organizations have no influence on health plan network design.
  B. A larger patient population increases pressure on the health plan to offer larger panels.

• Question 45:

  Greentree Medical, a health plan, is currently recruiting PCPs in preparation for its expansion into a new service area. Abigail Davis, a recruiter for Greentree, has been meeting with Melissa Cortelyou, M.D., in an effort to recruit her as a PCP in Green

  A. Greentree is prevented by law from offering a contract to Dr. Cortelyou until the credentialing process is complete
  B. any contract signed by Dr. Cortelyou should include a clause requiring the successful completion of the credentialing process within a defined time frame in order for the contract to be effective
  C. Greentree must offer a standard contract to Dr. Cortelyou, without regard to the outcome of the credentialing process
  D. Greentree will abandon the credentialing process now that Dr. Cortelyou has agreed to participate in Greentree's network
  B. any contract signed by Dr. Cortelyou should include a clause requiring the successful completion of the credentialing process within a defined time frame in order for the contract to be effective

• Question 46:

  Specialty services that have certain characteristics generally are good candidates for managed care approaches. These characteristics generally include that the specialty service should have

  A. appropriate, rather than inappropriate, utilization
  B. a defined patient population
  C. low, stable costs
  D. a benefit that cannot be easily defined
  B. a defined patient population

• Question 47:

  Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr. Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

  A. a traditional HMO plan
  B. a managed indemnity plan
  C. a point of service (POS) option
  D. an exclusive provider organization (EPO)
  C. a point of service (POS) option

• Question 48:

  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
  C. peer review only

• Question 49:

  When determining the premium rates it will charge a particular group, the Blue Jay Health Plan used a rating method known as community rating by class (CRC). Under this rating method, Blue Jay

  A. was allowed to use no more than four rating classes when determining how much to charge the group for health coverage
  B. was required to make the average premium in each class no more than 105% of the average premium for any other class
  C. divided its members into rating classes based on demographic factors, experience, or industry characteristics, and then charged each member in a rating class the same premium
  D. charged all employers or other group sponsors the same dollar amount for a given level of medical benefits, without adjustments for age, gender, industry, or experience
  C. divided its members into rating classes based on demographic factors, experience, or industry characteristics, and then charged each member in a rating class the same premium

• Question 50:

  Which facility would best meet the need of Jack who fell on road and sprained his ankle?

  A. Emergency Department
  B. Urgent Care Centre
  C. Home health care
  D. None of the above
  B. Urgent Care Centre