AHIP AHM-250 Online Practice Questions and Exam Preparation

AHIP AHM-250 Online Questions & Answers

• Question 81:

  Which of the following statements about EPO and HMO models is FALSE?

  A. In-network visit is allowed only on PCP's referral in HMO model.
  B. Out-of-network visit is not allowed in HMO model.
  C. Out-of-network visit is not allowed in EPO model.
  D. In-network visit is allowed only on PCP's referral in EPO model.
  A. In-network visit is allowed only on PCP's referral in HMO model.

• Question 82:

  Which of the following is(are) CORRECT?

  (A)

  Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.

  (B)

  Staff model HMOs are closed panel.

  (C)

  Staff model HMOs operate out of ambulatory care facilities.

  A. A and B
  B. None of the listed options
  C. B and C
  D. All of the listed options
  D. All of the listed options

• Question 83:

  When determining physicians' fee reimbursements, the Blossom Managed Healthcare Group assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier, as shown below:

  A. discounted fee-for-service system
  B. global capitation arrangement
  C. withhold arrangement
  D. relative value scale (RVS)
  D. relative value scale (RVS)

• Question 84:

  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
  C. All of the above

• Question 85:

  Certificate of Authority (COA) is subject to:

  A. Contract between health plan and employer
  B. State laws require an HMO not to be organized as a corporation
  C. Compliance with CMS
  D. an HMO may have to be licensed as an HMO or insurance company in each state in which it conducts business
  D. an HMO may have to be licensed as an HMO or insurance company in each state in which it conducts business

• Question 86:

  Consolidation of patient information in a single location as can be used by independent providers is an example of

  A. Structural Integration
  B. Operational Integration
  C. Business Integration
  D. None of the above
  D. None of the above

• Question 87:

  The Links Company, which offers its employees a self-funded health plan, signed a contract with a third party administrator (TPA) to administer the plan. The TPA handles the group's membership services and claims administration. The contract between Links

  A. a manual rating contract
  B. a funding vehicle contract
  C. an administrative services only (ASO) contract
  D. a pooling contract
  C. an administrative services only (ASO) contract

• Question 88:

  The following statements are about the accessibility of healthcare coverage and medical care in the United States. Select the answer choice that contains the correct statement.

  A. A person's employment status as a full-time employee guarantees that person access to healthcare coverage.
  B. Most people who have healthcare coverage are covered under an individual insurance policy rather than a group insurance plan.
  C. The percentage of the population without healthcare coverage is evenly distributed throughout the United States.
  D. Hospital closings have occurred disproportionately in rural areas and inner cities and have reduced access to healthcare in these areas.
  D. Hospital closings have occurred disproportionately in rural areas and inner cities and have reduced access to healthcare in these areas.

• Question 89:

  The following statements describe violations of antitrust legislation:

  Situation A - Two health plans in a single service area divided purchasers into two groups and agreed to each market their products to only one purchaser group.

  Situation B - A spec

  A. Situation A - horizontal division of markets Situation B - tying arrangement.
  B. Situation A - horizontal division of markets Situation B - price fixing.
  C. Situation A - horizontal group boycott Situation B - tying arrangement.
  D. Situation A - horizontal group boycott Situation B - price fixing.
  A. Situation A - horizontal division of markets Situation B - tying arrangement.

• Question 90:

  The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Three of these statements are true and one statement is false. Select the answer choice

  A. Factors that have increased the demand for behavioral healthcare services include increased stress on individuals and families and the increasing availability of behavioral healthcare services.
  B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) use only two basic strategies: alternative treatment levels and crisis intervention.
  C. The treatment approaches for behavioral healthcare most often include drug therapy, psychotherapy, and counseling.
  D. The development of alternative treatment options, incorporation of community-based resources into the healthcare system, and increased reliance on case management have shifted the emphasis of managed behavioral healthcare from meeting the service needs of
  B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) use only two basic strategies: alternative treatment levels and crisis intervention.