AHIP AHM-510 Online Practice Questions and Exam Preparation

AHIP AHM-510 Online Questions & Answers

• Question 1:

  The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.

  Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that produce unrelated products and services. Tidewater remains an independent corporation and continues to own Diversified and the subsidiaries. In order to create and maintain a common vision and goals among the subsidiaries, the management of Diversified makes decisions about strategic planning and budgeting for each of the businesses.

  In creating Diversified, Tidewater formed the type of company known as

  A. A mutual holding company
  B. A spin-off company
  C. An upstream holding company
  D. A downstream holding company
  D. A downstream holding company

• Question 2:

  Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

  The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its providernetwork. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

  From the following answer choices, select the response that identifies the type of market conduct examination that is being performed on Greenpath and the frequency with which the HMO Model Act requires state insurance departments to conduct an examination of an HMO's operations.

  A. Type of examination: comprehensive; Required frequency: annually
  B. Type of examination: comprehensive; Required frequency: at least every three years
  C. Type of examination: target; Required frequency: annually
  D. Type of examination: target; Required frequency: at least every three years
  B. Type of examination: comprehensive; Required frequency: at least every three years

• Question 3:

  The National Association of Insurance Commissioners (NAIC) adopted the Health Maintenance Organization Model Act (HMO Model Act) to regulate the development and operations of HMOs. One true statement regarding the HMO Model Act is that the act

  A. includes mental health services in its definition of basic healthcare services
  B. authorizes only one state agency-the department of insurance-to regulate HMOs
  C. requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired
  D. requires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members
  C. requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired

• Question 4:

  The following statements are about various provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Three of the statements are true and one statement is false. Select the answer choice that contains the FALSE statement.

  A. HIPAA permits group health plans that offer coverage through an HMO to impose affiliation periods during which no benefits or services are provided to a plan member.
  B. HIPAA created a new category of federal healthcare crimes, called federal healthcare offenses that apply to private healthcare plans as well as to federally funded healthcare programs.
  C. One effect of Section 231(h) of HIPAA, which amended the Social Security Act, has been to permit health plans with Medicare contracts to provide enrollees with value-added services such as discounted memberships to health clubs.
  D. HIPAA provides that any fines and penalties recovered through regulatory proceedings to enforce the federal fraud and abuse statutes will be turned over to enforcement agencies to conduct additional investigations.
  C. One effect of Section 231(h) of HIPAA, which amended the Social Security Act, has been to permit health plans with Medicare contracts to provide enrollees with value-added services such as discounted memberships to health clubs.

• Question 5:

  SoundCare Health Services, an MCO, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detecting violations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.

  By definition, the activity that SoundCare conducted when it examined its strengths, weaknesses, and capabilities is known as

  A. An environmental analysis
  B. An internal assessment
  C. An environmental forecast
  D. A community analysis
  B. An internal assessment

• Question 6:

  From the following answer choices, choose the term that best corresponds to this description. The SureQual Group is a group of practicing physicians and other healthcare professionals paid by the federal government to review services ordered or furnished by other practitioners in the same medical fields for the purpose of determining whether medical services provided were reasonable and necessary, and to monitor the quality of care given to Medicare patients.

  A. Health insuring organization (HIO)
  B. Independent practice association (IPA)
  C. Physician practice management (PPM) company
  D. Peer review organization (PRO)
  D. Peer review organization (PRO)

• Question 7:

  In 1994, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) revised their 1993 healthcare-specific antitrust guidelines to include analytical principles relating to multiprovider networks. Under the new guidelines, the regulatory agencies will use the rule ofreason to analyze joint pricing activities by competitors in physician or multiprovider networks only if

  A. Provider integration under the network is likely to produce significant efficiencies that benefit consumers
  B. The providers in a network share substantial financial risk
  C. The combining of providers into a joint venture enables the providers to offer a new product
  D. All of the above
  A. Provider integration under the network is likely to produce significant efficiencies that benefit consumers

• Question 8:

  In the paragraph below, a statement contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.

  In the case of Pacificare of Oklahoma, Inc. v. Burrage, the U.S. Court of Appeals for the Tenth Circuit considered whether ERISA preempts medical malpractice claims against health plans based on certain liability theories. In this case, the Tenth Circuit court held that ERISA (should / should not) preempt a liability claim against an HMO for the malpractice of one of its primary care physicians, and therefore the HMO was subject to a claim of (subordinated / vicarious) liability.

  A. Should / subordinated
  B. Should / vicarious
  C. Should not / subordinated
  D. Should not / vicarious
  D. Should not / vicarious

• Question 9:

  In developing its corporate strategies, the Haven Health Plan decided to implement a growth strategy that is focused on increasing the percentage of preventive health office visits from its current plan members. To accomplish this objective,

  Haven will send a direct mail kit to existing plan members to remind them of the variety of preventive health services that Haven currently offers, including physical exams, cholesterol tests, and mammograms.

  This information illustrates Haven's use of

  A. An intensive growth strategy known as market penetration
  B. An integrated growth strategy known as product development
  C. An integrated growth strategy known as market development
  D. A diversified growth strategy known as market penetration
  A. An intensive growth strategy known as market penetration

• Question 10:

  After conducting a business portfolio analysis, the Acorn Health Plan decided to pursue a harvest strategy with one of its strategic business units (SBUs)-Guest Behavioral Healthcare. By following a harvest strategy with Guest, Acorn most likely is seeking to

  A. Maximize Guest's short-term earnings and cash flow
  B. Increase Guest's market share
  C. Maintain Guest's market position
  D. Sacrifice immediate earnings in order to fund Guest's growth
  A. Maximize Guest's short-term earnings and cash flow