AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 61:

  The following statements are about federal laws that affect healthcare organizations. Select the answer choice containing the correct response.

  A. The Women's Health and Cancer Rights Act (WHCRA) of 1998 requires health plans to offer mastectomy benefits.
  B. The Health Care Quality Improvement Act (HCQIA) requires hospitals, group practices, and HMOs to comply with all standard antitrust legislation, even if these entities adhere to due process standards that are outlined in HCQIA.
  C. The Newborns' and Mothers' Health Protection Act (NMHPA) of 1996 mandates that coverage for hospital stays for childbirth must generally be a minimum of 24 hours for normal deliveries and 48 hours for cesarean births.
  D. Although the Mental Health Parity Act (MHPA) does not require health plans to offer mental health coverage, it imposes requirements on those plans that do offer mental health benefits.
  D. Although the Mental Health Parity Act (MHPA) does not require health plans to offer mental health coverage, it imposes requirements on those plans that do offer mental health benefits.

• Question 62:

  Medigap policies were standardized into ten standard benefit pl ranging from A-J by the ____

  A. Omnibus Budget Reconciliation Act (OBRA) of 1990
  B. Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982
  C. Medicare Modernization Act (MMA) of 2003
  D. Balanced Budget Act (BBA) of 1997
  A. Omnibus Budget Reconciliation Act (OBRA) of 1990

• Question 63:

  The existing committees at the Majestic Health Plan, a health plan that is subject to the requirements of HIPAA, include the Executive Committee and the Corporate Compliance Committee. The Executive Committee serves as a long-term advisory body on issues related to overall organizational policy. The Corporate Compliance Committee are convened to address specific management concerns. The following statement(s) can correctly be made about these committees:

  A. Majestic's Executive Committee is an example of a Specific committee.
  B. The Corporate Compliance Committee is an Example of an Adhoc company.
  C. A and B
  B. The Corporate Compliance Committee is an Example of an Adhoc company.

• Question 64:

  Which of the following statements is FALSE?

  A. The license that HMOs get in each state is called `Certificate of Authority'
  B. The HMO contracts directly with the individual physicians who provide the medical services to the HMO members in a variation of the IPA model called direct contract model HMO.
  C. All medicare/mediclaim beneficiaries should comply with utilization management requirements set forth by HCFA
  D. HMO's usually impose high coinsurance or deductible requirements
  D. HMO's usually impose high coinsurance or deductible requirements

• Question 65:

  Marlee Whitcomb was covered as a dependent under the group health plan provided by her father's employer. That health plan complied with the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986. When Ms. Whitcomb married, she c

  A. can continue her group coverage for a period not to exceed 48 months
  B. can continue her group coverage for a period not to exceed 36 months
  C. cannot continue her group coverage, but has the right to convert the group coverage to an individual health plan
  D. can continue her group coverage indefinitely
  B. can continue her group coverage for a period not to exceed 36 months

• Question 66:

  An HMO that combines characteristics of two or more HMO models is sometimes referred to as a

  A. Network model HMO
  B. Group model HMO
  C. Staff model HMO
  D. Mixed model HMO
  D. Mixed model HMO

• Question 67:

  In accounting terminology, the items of value that a company owns--such as cash, cash equivalents, and receivables--are generally known as the company's

  A. revenue
  B. net income
  C. surplus
  D. assets
  D. assets

• Question 68:

  The prudent layperson standard described in the Balanced Budget Act (BBA) of 1997 requires all hospitals that receive Medicare or Medicaid reimbursement to screen and, if necessary, stabilize all patients who come to their emergency departments.

  A. True
  B. False
  B. False

• Question 69:

  In health plan terminology, demand management, as used by health plans, can best be described as

  A. an evaluation of the medical necessity, efficiency, and/or appropriateness of healthcare services and treatment plans for a given patient
  B. a series of strategies designed to reduce plan members' needs to utilize healthcare services by encouraging preventive care, wellness, member self-care, and appropriate use of healthcare services
  C. a technique that prevents a provider who is being reimbursed under a fee schedule arrangement from billing a plan member for any fees that exceed the maximum fee reimbursed by the plan
  D. a system of identifying plan members with special healthcare needs, developing a healthcare strategy to meet those needs, and coordinating and monitoring the care
  B. a series of strategies designed to reduce plan members' needs to utilize healthcare services by encouraging preventive care, wellness, member self-care, and appropriate use of healthcare services

• Question 70:

  To set up and contribute to an HSA, an individual must:

  A. Be covered by a high-deductible health plan that meets federal requirements.
  B. Not have other health insurance.
  C. Not be enrolled in Medicare.
  D. All of the above.
  D. All of the above.