AHIP.AHM-250.v2019-03-23.q217

Exam Code:AHM-250
Exam Name:Healthcare Management: An Introduction
Certification Provider:AHIP
Free Question Number:217
Version:v2019-03-23
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Exam Question List
Question 1: One way in which health plans differ from traditional indemn...
Question 2: Greentree Medical, a health plan, is currently recruiting PC...
Question 3: Health plans may use different capitation arrangements for d...
Question 4: By offering a comprehensive set of healthcare benefits to it...
Question 5: In the United States, the Department of Defense offers ongoi...
Question 6: One of the most influential pieces of legislation in the adv...
Question 7: If left unresolved, member complaints about the actions or d...
Question 8: All CDHP products provide federal tax advantages while allow...
Question 9: The Employee Retirement Income Security Act (ERISA) requires...
Question 10: The application of health plan principles to workers' compen...
Question 11: Arthur Moyer is covered under his employer's group health pl...
Question 12: Federal Employee Health Benefits Program (FEHBP) requires he...
Question 13: In certain situations, a health plan can use the results of ...
Question 14: If most of the physicians, or many of the physicians in a pa...
Question 15: Which of the following is WRONG?...
Question 16: Most contracts between health plans and providers contain a ...
Question 17: Janet Riva is covered by an indemnity health insurance plan ...
Question 18: Bart Vereen is insured by both a traditional indemnity healt...
Question 19: In certain situations, a health plan can use the results of ...
Question 20: Members who qualify to participate in a health plan's case m...
Question 21: By definition, a health plan's network refers to the:...
Question 22: The following paragraph contains an incomplete statement. Se...
Question 23: The following statement can be correctly made about Medicare...
Question 24: Medicare Part C can be delivered by the following Medicare A...
Question 25: One HMO model can be described as an extension of a group mo...
Question 26: Which out of the three is accomplished through precertificat...
Question 27: Some states mandate that an independent enrollment broker or...
Question 28: From the answer choices below, select the response that corr...
Question 29: The prudent layperson standard described in the Balanced Bud...
Question 30: Dr. Julia Phram is a cardiologist under contract to Holcomb ...
Question 31: Employer-sponsored benefit plans that provide healthcare ben...
Question 32: In most cases, medical errors are caused by breakdowns in th...
Question 33: Because many patients with behavioral health disorders do no...
Question 34: The Clover Group is a for-profit MCO that operates in the Un...
Question 35: Many HMOs are compensated for the delivery of healthcare to ...
Question 36: One true statement regarding ethics and laws is that the val...
Question 37: Bill Clinton is a member of Lewinsky's PBM plan which has a ...
Question 38: A health plan may use one of several types of community rati...
Question 39: One true statement regarding ethics and laws is that the val...
Question 40: Historically most HMOs have been...
Question 41: Before an HMO contracts with a physician, the HMO first veri...
Question 42: The process of identifying and classifying the risk represen...
Question 43: One true statement about community rating, a rating method c...
Question 44: The following paragraph contains an incomplete statement. Se...
Question 45: In the United States, the Department of Defense offers ongoi...
Question 46: From the following answer choices, choose the description of...
Question 47: Health plans' use of the Internet to provide plan members wi...
Question 48: The contract between the Honolulu MCO and Beverley Hills Hos...
Question 49: Dr. Milton Ware, a physician in the Riverside MCO's network ...
Question 50: As part of its quality management program, the Lyric Health ...
Question 51: A common physician-only integrated model is a group practice...
Question 52: The data evaluation stage of utilization review (UR) include...
Question 53: Phillip Tsai is insured by both an indemnity health insuranc...
Question 54: Provider integration has two components: operational integra...
Question 55: One distinction that can be made between a staff model HMO a...
Question 56: In accounting terminology, the items of value that a company...
Question 57: Specialty services with certain characteristics tend to make...
Question 58: The National Association of Insurance Commissioners (NAIC) d...
Question 59: The criteria used to identify and measure healthcare quality...
Question 60: Amendments to the HMO act 1973 do not permit federally quali...
Question 61: From the following answer choices, choose the description of...
Question 62: Health plans sometimes contract with independent organizatio...
Question 63: The Ark Health Plan, is currently recruiting providers in pr...
Question 64: Member satisfaction is a critical element of a health plan's...
Question 65: Consumer-directed health plans are not a new concept. They a...
Question 66: ______________ HMOs can't medically underwrite any group - i...
Question 67: Which of the following is CORRECT?...
Question 68: Salient features of a Health Savings Account include all of ...
Question 69: One distinguishing characteristic of a health maintenance or...
Question 70: For providers, integration occurs when two or more previousl...
Question 71: The following statements describe two types, or models, of H...
Question 72: Identify the CORRECT statement(s): (A) Smaller the group, th...
Question 73: From the following answer choices, choose the description of...
Question 74: Federal legislation has placed the primary responsibility fo...
Question 75: Mr. George Bush is covered by a PBM plan that uses a closed ...
Question 76: Parable Healthcare Providers, a health plan, recently segmen...
Question 77: One characteristic of disease management programs is that th...
Question 78: A physician-hospital organization (PHO) may be classified as...
Question 79: Which of the following is NOT a preventive care initiative o...
Question 80: The Ark Health Plan, is currently recruiting providers in pr...
Question 81: One of the distinguishing characteristics of healthcare mark...
Question 82: One ethical principle in health plans is the principle of no...
Question 83: An exclusive provider organization (EPO) operates much like ...
Question 84: From the following answer choices, choose the description of...
Question 85: Ronald Canton is a member of the Omega MCO. He receives his ...
Question 86: Specialty services that have certain characteristics general...
Question 87: The Polestar Company's sole business is the ownership of Pol...
Question 88: After a somewhat modest start in 2004, enrollment in HSA-rel...
Question 89: When the Knoll Company purchased group health coverage from ...
Question 90: The administrative simplification standards described under ...
Question 91: Primary care case managers (PCCMs) provide managed healthcar...
Question 92: Col. Martin Avery, on active duty in the U.S. Army, is eligi...
Question 93: In assessing the potential degree of risk represented by a p...
Question 94: Which of the following statements about EPO & HMO models...
Question 95: Pharmacy benefit management (PBM) companies typically intera...
Question 96: The Fairway Health Group contracted with the Empire Corporat...
Question 97: In 1999, the United States Congress passed the Financial Ser...
Question 98: Health plans use the following to determine the number of pr...
Question 99: Each of the following statements describes a health plan tha...
Question 100: In order to compensate for lost revenue resulting from servi...
Question 101: The following sentence contains an incomplete statement with...
Question 102: The Cleopatra Group, a third-party administrator (TPA), has ...
Question 103: The Azure Group is a for-profit health plan that operates in...
Question 104: In order to cover some of the gap between FFS Medicare cover...
Question 105: Appropriateness of treatment provided is determined by devel...
Question 106: Marlee Whitcomb was covered as a dependent under the group h...
Question 107: HMOs typically employ several techniques to manage provider ...
Question 108: One feature of the Employee Retirement Income Security Act (...
Question 109: The Blaine Healthcare Corporation seeks to manage its qualit...
Question 110: A health plan's ability to establish an effective provider n...
Question 111: Managed behavioral health organizations (MBHOs) use several ...
Question 112: Before the Hill Health Maintenance Organization (HMO) receiv...
Question 113: Immediate evaluation and treatment of illness or injury can ...
Question 114: In 1999, the United States Congress passed the Financial Ser...
Question 115: The existing committees at the Majestic Health Plan, a healt...
Question 116: One typical characteristic of an integrated delivery system ...
Question 117: Medicare is the federal government program established under...
Question 118: One device that PBM plans use to manage both the cost and us...
Question 119: The Hill Health Plan designed a set of benefits that it pack...
Question 120: In the paragraph below, a sentence contains two pairs of wor...
Question 121: Parul Gupta has been covered by a group health plan for eigh...
Question 122: The Advantage Health Plan recently added the following featu...
Question 123: Health savings accounts were created by which of the followi...
Question 124: System classifies hundreds of hospital services based on a n...
Question 125: Patrick Flaherty's employer has contracted to receive health...
Question 126: A particular health plan offers a higher level of benefits f...
Question 127: One way in which a health plan can support an ethical enviro...
Question 128: In order to help review its institutional utilization rates,...
Question 129: The following programs are typically included in TRICARE med...
Question 130: In addition to the credentialing activities that a health pl...
Question 131: A medical foundation is a not-for-profit entity that purchas...
Question 132: For this question, select the answer choice containing the t...
Question 133: As part of its utilization management (UM) system, the Popla...
Question 134: In large health plans, management functions such as provider...
Question 135: One factor the Sandpiper Health Plan uses to assess its qual...
Question 136: Phoebe Urich is covered by a traditional indemnity health in...
Question 137: Beginning in the early 1980s, several factors contributed to...
Question 138: Ashley Martin is covered by a managed healthcare plan that s...
Question 139: One way in which a health plan can support an ethical enviro...
Question 140: During an open enrollment period in 1997, Amy Hadek enrolled...
Question 141: As part of its utilization management (UM) system, the Creol...
Question 142: The following organizations are the primary sources of accre...
Question 143: The existing committees at the Majestic Health Plan, a healt...
Question 144: Before the Leo Health Maintenance Organization (HMO) receive...
Question 145: All good Medical, Inc., a health plan, has contracted with M...
Question 146: One type of physician-only integration model is a consolidat...
Question 147: Ian Vladmir wants to have a routine physical examination to ...
Question 148: The Acme HMO recruits and contracts directly with a wide ran...
Question 149: The Courtland PPO maintains computerized records that includ...
Question 150: Khalyn Drury's employer includes managed dental care in its ...
Question 151: The Citywide Health Group is a large provider-based health p...
Question 152: Which of the following is NOT a reason for conducting utiliz...
Question 153: Advantages of EDI over manual data management systems...
Question 154: More procedures or services may be fully covered within the ...
Question 155: Lansdale Healthcare, a health plan, offers comprehensive hea...
Question 156: One non-group market segment to which health plans market he...
Question 157: One of the most influential pieces of legislation in the adv...
Question 158: Health plans can organize under a not-for-profit form or a f...
Question 159: One ethical principle in managed care is the principle of ju...
Question 160: Paul Gilbert has been covered by a group health plan for two...
Question 161: From the following choices, choose the definition that best ...
Question 162: To address the problems associated with multiple data manage...
Question 163: Primary care case managers (PCCMs) provide case management s...
Question 164: An HMO that combines characteristics of two or more HMO mode...
Question 165: Eleanor Giambi is covered by a typical 24-hour managed care ...
Question 166: Medicaid is a jointly funded federal and state program that ...
Question 167: In order to generate exchanges with consumers, healthcare pl...
Question 168: Before the Hill Health Maintenance Organization (HMO) receiv...
Question 169: The following statements are about the non-group market for ...
Question 170: Dr. Samuel Aldridge's provider contract with the Badger Heal...
Question 171: Following a report by the Institute of Medicine on the incid...
Question 172: One characteristic of the accreditation process for MCOs is ...
Question 173: In the paragraph below, two statements each contain a pair o...
Question 174: From the following choices, choose the definition that best ...
Question 175: The Conquest Corporation contracts with the Apex health plan...
Question 176: By definition, the marketing process of defining a certain p...
Question 177: In preparation for its expansion into a new service area, th...
Question 178: The agreement by two or more independent competitors on the ...
Question 179: Several marketplace factors helped fuel the movement toward ...
Question 180: Some providers use electronic medical records (EMRs) to docu...
Question 181: Janet Riva is covered by a traditional indemnity health insu...
Question 182: Medicare Advantage product options include:...
Question 183: A public employer, such as a municipality or county governme...
Question 184: One typical characteristic of preferred provider organizatio...
Question 185: Many of the credentialing standards and criteria used by hea...
Question 186: In response to the demand for a method of assessing outcomes...
Question 187: Natalie Chan is a member of the Ultra Health Plan, a health ...
Question 188: The following types of CDHPs allow federal tax advantages in...
Question 189: The following programs are part of the Alcove MCO's utilizat...
Question 190: In order to measure the expenses of institutional utilizatio...
Question 191: Health plans require utilization review for all services adm...
Question 192: One component of information systems used by health plans in...
Question 193: In health plan terminology, demand management, as used by he...
Question 194: In claims administration terminology, a claims investigation...
Question 195: General HMO is building a provider network and is considerin...
Question 196: Al Marak, a member of the Frazier Health Plan, has asked for...
Question 197: Ed O'Brien has both Medicare Part A and Part B coverage. He ...
Question 198: Using a code for a procedure or diagnosis that is more compl...
Question 199: John Kerry's employer has contracted to receive healthcare f...
Question 200: The prudent layperson standard described in the Balanced Bud...
Question 201: Merle Spencer has coverage under both Medicare Part A and Me...
Question 202: The following sentence contains an incomplete statement with...
Question 203: Although the process is voluntary for health plans, external...
Question 204: According to the IRS, which of the following is not an allow...
Question 205: One way that MCOs involve providers in risk sharing is by re...
Question 206: Brokers are one type of distribution channel that health pla...
Question 207: Phillip Tsai is insured by both a traditional indemnity heal...
Question 208: PBM plans operate under several types of contractual arrange...
Question 209: If a state commissioner of insurance places an HMO under adm...
Question 210: Ed Murray is a claims analyst for a managed care plan that p...
Question 211: In the following sections, we will describe some of the meas...
Question 212: Emily Brown works for Integral Health Plan and represents th...
Question 213: The following programs are part of the Alcove Health Plan's ...
Question 214: During the risk assessment process for a traditional indemni...
Question 215: A health savings account must be coupled with an HDHP that m...
Question 216: Health plans often program into their claims processing syst...
Question 217: Individuals can use HSAs to pay for the following types of h...