AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 71:

  Ed O'Brien has both Medicare Part A and Part B coverage. He also has coverage under a PBM plan that uses a closed formulary to manage the cost and use of pharmaceuticals. Recently, Mr. O'Brien was hospitalized for an aneurysm. Later, he was transferred by

  A. Confinement in the extended-care facility after his hospitalization.
  B. Transportation by ambulance from the hospital to the extended-care facility.
  C. Physicians' professional services while he was hospitalized.
  D. physicians' professional services while he was at the extended-care facility.
  A. Confinement in the extended-care facility after his hospitalization.

• Question 72:

  In 1999, the United States Congress passed the Financial Services Modernization Act, referred to as the Gramm-Leach-Bliley (GLB) Act. The primary provisions included under the GLB Act require financial institutions, including health plans, to take several

  A. Notify customers of any sharing of non-public personal financial information with nonaffiliated third parties.
  B. Prohibit customers from having the opportunity to 'opt-out' of sharing non-public personal financial information.
  C. Disclose to affiliates, but not to third parties, their privacy policies regarding the sharing of nonpublic personal financial information.
  D. Agree not to disclose personally identifiable financial information or personally identifiable health information.
  A. Notify customers of any sharing of non-public personal financial information with nonaffiliated third parties.

• Question 73:

  Which of the following is NOT a reason for conducting utilization reviews?

  A. Improve the quality and cost effectiveness of patient care
  B. Reduce unnecessary practice variations
  C. Make appropriate authorization decisions
  D. Accommodate special requirements of inpatient care
  D. Accommodate special requirements of inpatient care

• Question 74:

  The criteria used to identify and measure healthcare quality are generally divided into three categories: structure, process, and outcomes measures. Structure measures, which relate to the nature and quality of the resources that a health plan has available

  A. length of time patients have to wait at the office to be seen by a provider
  B. percentage of plan physicians who are board-certified
  C. percentage of children receiving immunizations
  D. number of patients contracting an infection in the hospital
  B. percentage of plan physicians who are board-certified

• Question 75:

  One non-group market segment to which health plans market health plan products is the senior market, which is comprised mostly of persons over age 65 who are eligible for Medicare benefits. One factor that affects a health plan's efforts to market to the

  A. The Centers for Medicare and Medicaid Services (CMS) must approve all marketing materials used by health plans to market health plan products to the Medicare population
  B. managed Medicare plans typically require Medicare beneficiaries to purchase Medigap insurance to supplement gaps in coverage
  C. managed Medicare plans can refuse to cover persons with certain health problems
  D. the CMS prohibits health plans from using telemarketing to market health plan products to the Medicare population
  B. managed Medicare plans typically require Medicare beneficiaries to purchase Medigap insurance to supplement gaps in coverage

• Question 76:

  The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

  A. Has ever participated in any quality improvement activities.
  B. Is a participating provider in a health plan that will compete with Ark in its new service area.
  C. Meets the requirements of the Ethics in Patient Referrals Act.
  D. Has had a medical malpractice claim filed or other disciplinary actions taken against her.
  D. Has had a medical malpractice claim filed or other disciplinary actions taken against her.

• Question 77:

  Phillip Tsai is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of

  A. $0
  B. $300
  C. $400
  D. $900
  C. $400

• Question 78:

  The contract between the Honolulu MCO and Beverley Hills Hospital contains a 90 day cure provision. The Beverley Hills Hospital breached one of the contract requirements on July 31, 2004. The hospital remedied the problem by October 31, 2004. Which of the following answer is right?

  A. The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.
  B. The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.
  C. The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.
  D. The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.
  C. The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.

• Question 79:

  Ashley Martin is covered by a managed healthcare plan that specifies a $300 deductible and includes a 30% coinsurance provision for all healthcare obtained outside the plan's network of providers. In 1998, Ms. Martin became ill while she was on vacation,

  A. $300
  B. $510
  C. $600
  D. $810
  D. $810

• Question 80:

  The following statement(s) can correctly be made about the characteristics of reports that should be provided to managers for use in managing a healthcare delivery system:

  A. Users typically need access to all the raw data used to generate reports
  B. Info
  C. Both A and B
  D. A only
  E. B only
  F. Neither A nor B
  D. A only