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Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Questions 21

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:

Options:

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

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Questions 22

The Koster Company plans to purchase a health plan for its employees from Intuitive HMO. Intuitive will administer the plan and will bear the responsibility of guaranteeing claim payments by paying all incurred covered benefits. Koster will pay for the he

Options:

A.

fully funded plan

B.

stop-loss plan

C.

self-pay plan

D.

self-funded plan

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Questions 23

One among the following is a reason that limit access to health care for US people.

Options:

A.

Life Style of the people

B.

Concentration of physicians in highly populated areas.

C.

Advancement in information technology

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Questions 24

Combined system of preventive, diagnostic and therapeutic measures that focuses on management of specific chronic illness or medical conditions are:

Options:

A.

Utilization Review

B.

Case Management

C.

Demand Management

D.

Disease management

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Questions 25

Which of the following statements about the Title VII of the Civil Rights Act is WRONG?

Options:

A.

Employers with more than 15 employees engaged in interstate commerce need to comply

B.

Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide coverage during childbirth and related medical conditions on the same basis as they provide coverage for other medical conditions

C.

Allows HMOs to set different policies for people from different races, religions, sex or national origin to safeguard their interests.

D.

Protects all employees

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Questions 26

The following statements are about the underwriting function within a health plan. Select the answer choice containing the correct statement.

Options:

A.

The underwriting function in a health plan is primarily concerned with ensuring that the group being underwritten does not include any individuals who are likely to have higher than average utilization of medical services.

B.

Compared to a health plan with relaxed underwriting requirements, a similar health plan with very strict underwriting requirements can expect to experience increased healthcare costs and to have significantly higher plan enrollment.

C.

Typically, a health plan guarantees the premium rate for a group health contract for a period of no more than six months.

D.

In order to determine the actual premium to charge a group, a group underwriter typically considers such factors as level of participation, benefits, and the age and gender distribution of group members.

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Questions 27

The Panacea Healthcare System is a single large medical practice based in Oakland, California. The physicians of Panacea operate through a single office located in the Beverly Hills region of Oakland & do have access to the same medical records. Panacea is owned by Queen's hospital & before Panacea acquired the practices of its participating physicians, these physicians were independent practitioners. Which of the following terms best describes Panacea?

Options:

A.

Physician Practice Management Compare

B.

Physician Hospital Organization

C.

Consolidated Medical Group

D.

None of the above

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Questions 28

The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

Options:

A.

A decision as to which exclusions or limitations would apply for this product.

B.

A decision as to how to establish the network of participating providers for this product

C.

A determination of the level at which this product would cover out-of-network services.

D.

All of the above.

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Questions 29

Which of the following population groups are eligible for Medicare coverage

Options:

A.

Individuals aged 65 & above, regardless of income & medical history

B.

Individuals suffering from end stage renal disease, regardless of age

C.

Individuals aged 50 or above suffering from qualifying disabilities

D.

Both A & B

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Questions 30

Each time a patient visits a provider he has to pay a fixed dollar amount?

Options:

A.

Deductible

B.

Copayment

C.

Capitation

D.

Co-insurance

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