AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 51:

  The feature that formed the foundation of Health Maintenance Act of 1973

  A. Federal Qualification Requirements

  B. Exemption from state laws

  C. All of the above

  Correct Answer: C

• Question 52:

  A differences between managed indemnity and traditional indemnity

  A. Include precertification and utilization review techniques

  B. Both are the same

  C. Include network and quality review techniques

  D. A and B

  Correct Answer: C

• Question 53:

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

  A. anti selection

  B. cost shifting

  C. receivership

  D. underwriting

  Correct Answer: B

• Question 54:

  The following statements describe corporate transactions:

  Transaction A: An MCO acquired another MCO.

  Transaction B: A group of providers formed an organization to carry out billings, collections, and

  contracting with MCOs for the entire group of provide

  A. A and C only

  B. A, B, and C

  C. B and C only

  D. A and B only

  Correct Answer: A

• Question 55:

  The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the hi

  A. $60

  B. $80

  C. $120

  D. $160

  Correct Answer: B

• Question 56:

  The process of identifying and classifying the risk represented by an individual or group is called

  A. Rating

  B. Anti selection

  C. Underwriting

  D. None of the above

  Correct Answer: C

• Question 57:

  Which is an advantage of a for-profit health plan?

  A. Flexibility in raising capital

  B. Double taxation

  C. Exemption from paying federal income taxes.

  D. None of the above.

  Correct Answer: A

• Question 58:

  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

  Correct Answer: B

• Question 59:

  The process of calculating the appropriate premium to charge purchasers, given the degree of risk represented by the individual or group, the expected costs to deliver medical services, and the expected marketability and competitiveness of the health plan

  A. financing

  B. rating

  C. underwriting

  D. budgeting

  Correct Answer: B

• Question 60:

  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.

  Correct Answer: B