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Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Questions 41

The nature of the claims function within health plans varies by type of plan and by the compensation arrangement that the plan has made with its providers. For example, it is generally correct to say that, in a

Options:

A.

Preferred provider organization (PPO), the

B.

Both A and B

C.

A only

D.

B only

E.

Neither A nor B

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Questions 42

The Mirror Health Plan uses a form of computer/telephony integration (CTI) to manage telephone calls coming into its member services department. When a member calls the plan's central telephone number, a device answers the call with a recorded message and

Options:

A.

a member outreach program

B.

a complaint resolution procedure (CRP)

C.

an automatic call distributor (ACD)

D.

an interactive voice response (IVR) system

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Questions 43

The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

Options:

A.

Both A and B

B.

A only

C.

B only

D.

Neither A nor B

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Questions 44

Which facility would best meet the need of Jack who fell on road and sprained his ankle?

Options:

A.

Emergency Department

B.

Urgent Care Centre

C.

Home health care

D.

None of the above

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Questions 45

The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.

According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

Options:

A.

$60

B.

$80

C.

$120

D.

$160

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Questions 46

The owners of an MCO typically delegate authority for governing the operation of the MCO by electing the MCO's

Options:

A.

quality management committee

B.

medical director

C.

board of directors

D.

chief executive officer

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Questions 47

The following statement(s) can correctly be made about electronic data interchange (EDI):

Options:

A.

EDI differs from eCommerce in that EDI involves back-and-forth exchanges of information concerning individual transactions, whereas eCommerce is the transfer of d

B.

Both A and B

C.

A only

D.

B only

E.

Neither A nor B

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Questions 48

The following statements apply to Archer medical savings accounts. Select the answer choice that contains the correct statement.

Options:

A.

MSAs were established as a demonstration project under the Medicare Modernization Act.

B.

MSAs were seen as an improvement over FSAs because they are portable, allowing employees to take the funds with them when they change jobs.

C.

The popularity of MSAs has been limited because funds may not be rolled over from year to year.

D.

MSAs are one of the fastest growing Types of Consumer-Directed Health Plans.

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Questions 49

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.

The number of specialists in Hill's network of providers.

B.

The price for the PPO product.

C.

Hill's ability to report utilization data.

D.

Hill's use of brokers to market its PPO product.

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Questions 50

The agreement by two or more independent competitors on the prices or fees that they will charge for services is known as:

Options:

A.

Tying arrangements

B.

Price fixing

C.

Horizontal group boycott

D.

Horizontal division of markets

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