AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 51:

  Health plans use the following to determine the number of providers to add to a network:

  A. Staffing ratios
  B. Drive time
  C. Geographic availability
  D. All of the above
  D. All of the above

• Question 52:

  To address the problems associated with multiple data management systems, the Kayak Health Plan has begun to use a data warehouse. One likely characteristic of Kayak's data warehouse is that:

  A. It requires Kayak's individual databases to store large amounts of data that are not needed for daily operations.
  B. It contains data from internal sources only.
  C. It stores historical data rather than current data.
  D. The data in the warehouse are linked by a common subject.
  D. The data in the warehouse are linked by a common subject.

• Question 53:

  Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

  A. fixed amount in advance for each medical service the member receives
  B. a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider
  C. a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services
  D. specified amount of the member's medical expenses before any benefits are paid by the HMO
  C. a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services

• Question 54:

  Ancillary services are

  A. General medical care that is provided directly to a patient without referral from another physician
  B. Also known as secondary care (Medical care that is delivered by specialist)
  C. Supplemental services needed as part of providing other care
  D. Outpatient services provided by a hospital or other qualified ambulatory care facility which require inpatient stay
  C. Supplemental services needed as part of providing other care

• Question 55:

  Calculate the hospital bed days per 1000 members for the Month to date (MTD) on 25 April, with plan membership of 25,000 and total gross hospital bed days in MTD is 300 for an XYZ Health plan?

  A. 175
  B. 480
  C. 1000
  D. 365
  A. 175

• Question 56:

  Flexible Spending Accounts (FSAs) can be established by

  A. The employer alone
  B. The employee alone
  C. By both the employer and the employee
  D. Self - employed individuals
  A. The employer alone

• Question 57:

  One distinction that can be made between a staff model HMO and a group model HMO is that, in a staff model HMO, participating physicians are Back to Top

  A. Employees of the HMO
  B. Employees of a group practice that has contracted with the HMO
  C. Compensated primarily through capitation
  D. Limited to primary care physicians (PCPs)
  A. Employees of the HMO

• Question 58:

  The following statement can be correctly made about Medicare Advantage eligibility:

  A. Individuals enrolled in a MA plan must enroll in a stand-alone Part D prescription drug plan.
  B. Individuals enrolled in a MA plan do not have to be eligible for Medicare Part A
  C. Individuals enrolled in an MSA plan or a PFFS plan without Medicare drug coverage can enroll in Medicare Part D.
  D. Individuals can enroll in MA plan in multiple regions.
  C. Individuals enrolled in an MSA plan or a PFFS plan without Medicare drug coverage can enroll in Medicare Part D.

• Question 59:

  Many of the credentialing standards and criteria used by health plans are often taken from already existing standards established by

  A. the National Practitioner Data Bank (NPDB)
  B. the National Association of Insurance Commissioners (NAIC)
  C. the Centers for Medicare and Medicaid Services (CMS)
  D. independent accrediting organizations
  D. independent accrediting organizations

• Question 60:

  Members who qualify to participate in a health plan's case management program are typically assigned a case manager. During the course of the member's treatment, the case manager is responsible for

  A. Coordinating and monitoring the member's care
  B. Approve
  C. Both A and B
  D. A only
  E. B only
  F. Neither A nor B
  B. Approve