AHIP AHM-250 Secret 2021

Ucertify offers free demo for AHM-250 exam. "Healthcare Management: An Introduction", also known as AHM-250 exam, is a AHIP Certification. This set of posts, Passing the AHIP AHM-250 exam, will help you answer those questions. The AHM-250 Questions & Answers covers all the knowledge points of the real exam. 100% real AHIP AHM-250 exams and revised by experts!

Free demo questions for AHIP AHM-250 Exam Dumps Below:

NEW QUESTION 1

Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

  • A. fixed amount in advance for each medical service the member receives
  • B. a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider
  • C. a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services
  • D. specified amount of the member's medical expenses before any benefits are paid by the HMO

Answer: C

NEW QUESTION 2

Calculate the hospital bed days per 1000 members for the Month to date (MTD) on 25 April, with plan membership of 25,000 and total gross hospital bed days in MTD is 300 for an XYZ Health plan?

  • A. 175
  • B. 480
  • C. 1000
  • D. 365

Answer: A

NEW QUESTION 3

Select the correct statement regarding TRICARE Extra plan options to military personnel’s.

  • A. Out of pocket expenses are generally high in tricare extra than TRICARE standard
  • B. Enrollment is not necessary to participate in TRICARE Extra
  • C. TRICARE Extra provides coordinated care managed by primary care case manager

Answer: C

NEW QUESTION 4

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

Answer: C

NEW QUESTION 5

The Azure Group is a for-profit health plan that operates in the United States. The Fordham Group owns all of Azure's stock. The Fordham Group's sole business is the ownership of controlling interests in the shares of other companies. This information ind

  • A. A holding company of the Fordham Group.
  • B. A sister corporation of the Fordham Group.
  • C. A subsidiary of the Fordham Group.
  • D. All of the above.

Answer: C

NEW QUESTION 6

Abbreviation for JCAHO is

  • A. Joint Coordination on Accreditation of Healthcare Organizations
  • B. Joint Commission on Accreditation of Healthcare Organizations
  • C. Joint Corporation on Accreditation of Healthcare Organizations
  • D. Joint Connection on Accreditation of Healthcare Organizations

Answer: B

NEW QUESTION 7

The Robust Health Plan sometimes uses prospective experience rating to calculate the premiums for a group. Under prospective experience rating, Robust most likely will:

  • A. At the end of a rating period, the financial gains and losses experienced by the group during that rating period and, if the group's experience during the period is better than expected, refund part of the group's premium in the form of an experience ratio
  • B. Use Robust's average experience with all groups to calculate this particular group's premium.
  • C. Use the group's past experience to estimate the group's expected experience for the next period.
  • D. All of the above

Answer: C

NEW QUESTION 8

Using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider is called

  • A. Coding error
  • B. Overcharging
  • C. Upcoming
  • D. Unbundling

Answer: C

NEW QUESTION 9

During the risk assessment process for a traditional indemnity group insurance health plan, group underwriters consider such characteristics as a group’s geographic location, the size and gender mix of the group, and the level of participation in the grou

  • A. Healthcare costs are typically higher in rural areas than in large urban areas.
  • B. The morbidity rate for males is higher than the morbidity rate for females.
  • C. The larger the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.
  • D. All of the above

Answer: C

NEW QUESTION 10

An HMO that combines characteristics of two or more HMO models is sometimes referred to as a

  • A. Network model HMO
  • B. Group model HMO
  • C. Staff model HMO
  • D. Mixed model HMO

Answer: D

NEW QUESTION 11

The Madison Health Plan, a national MCO, and a local hospital system that operates its own managed healthcare network recently created a new and separate managed healthcare organization, the Pineapple Health Plan. Madison and the hospital system share own

  • A. a consolidation
  • B. a joint venture
  • C. a merger
  • D. an acquisition

Answer: B

NEW QUESTION 12

Specialty services that have certain characteristics generally are good candidates for managed care approaches. These characteristics generally include that the specialty service should have

  • A. appropriate, rather than inappropriate, utilization
  • B. a defined patient population
  • C. low, stable costs
  • D. a benefit that cannot be easily defined

Answer: B

NEW QUESTION 13

High deductible health plans (HDHP) are characterized by all of the following features except

  • A. A HDHPs have a higher deductible than other traditional insurance products such as HMOs & PPOs.
  • B. HDHPs generally cost more than traditional heathcare coverage.
  • C. Some HDHPs cover preventive care on a first-dollar coverage basis.
  • D. All of the above

Answer: A

NEW QUESTION 14

The measures used to evaluate healthcare quality are generally divided into three categories: process, structure and outcomes. An example of a process measure that can be used to evaluate an MCO's performance is the

  • A. percentage of board certified physicians within the MCO's network
  • B. number of hospital admissions for plan members with certain medical conditions
  • C. number of plan members contracting an infection in the hospital
  • D. percentage of adult plan members who receive regular medical checkups

Answer: D

NEW QUESTION 15

One typical characteristic of preferred provider organization (PPO) benefit plans is that PPOs:

  • A. Assume full financial risk for arranging medical services for their members.
  • B. Require plan members to obtain a referral before getting medical services from specialists.
  • C. Use a capitation arrangement, instead of a fee schedule, to reimburse physicians.
  • D. Offer some coverage, although at a higher cost, for plan members who choose to use the services of non-network providers.

Answer: D

NEW QUESTION 16

The following statement(s) can correctly be made about Medicaid managed care plans:

  • A. A state may mandate health plan enrollment if it offers enrollees in non-rural areas a choice of at least two health plans and offers rural enrollees a choice of at lea
  • B. Both A and B
  • C. A only
  • D. B only
  • E. Neither A nor B

Answer: A

NEW QUESTION 17

Janet Riva is covered by a indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred
$2,500 in medical expenses that were covered by her health plan. She incurred

  • A. $1,750
  • B. $1,800
  • C. $2,000
  • D. $2,250

Answer: B

NEW QUESTION 18

HMOs typically employ several techniques to manage provider utilization and member utilization of medical services. One technique that an HMO uses to manage member utilization is

  • A. the use of physician practice guidelines
  • B. the requirement of copayments for office visits
  • C. capitation
  • D. risk pools

Answer: B

NEW QUESTION 19

Mr. George Bush is covered by a PBM plan that uses a closed formulary. This indicates that

  • A. he can receive coverage for pharmaceuticals only if they are on the PBM plan's preferred list of drugs
  • B. he must receive all of his pharmaceuticals from a mail-order pharmacy program
  • C. he can receive coverage for pharmaceuticals that are on the PBM plan's preferred list of drugs, as well as for pharmaceuticals that are not on the preferred list
  • D. the PBM plan cannot receive a rebate on any pharmaceuticals it obtains from the pharmaceutical facture

Answer: A

NEW QUESTION 20

Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

  • A. an integrated delivery system (IDS)
  • B. a Management Services Organization (MSO)
  • C. a Physician Practice Management (PPM) company
  • D. a physician-hospital organization (PHO)

Answer: A

NEW QUESTION 21

Which of the following job descriptions best match the job of a telephone triage staff
member?

  • A. Check patient vitals, write prescriptions, administer drugs.
  • B. Greet patients at the door, collect insurance information, schedule appointments, collect payments.
  • C. Determine urgency of the condition, notify emergency department, schedule appointments, authorize referrals, provide self-care information.
  • D. None of the above.

Answer: C

NEW QUESTION 22

One characteristic of disease management programs is that they typically

  • A. focus on individual episodes of medical care rather than on the comprehensive care of the patient over time
  • B. are used to coordinate the care of members with any type of disease, either chronic or nonchronic
  • C. focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition
  • D. use clinical practice processes to standardize the implementation of best practices among providers

Answer: D

NEW QUESTION 23

Which of the following factors have contributed to the limited popularity of FSAs

  • A. "Use it or lose it" provision
  • B. Lack of portability
  • C. Only self-employed individuals are eligible for establishing FSAs.
  • D. Both A &B

Answer: D

NEW QUESTION 24

Merle Spencer has coverage under both Medicare Part A and Medicare Part B. Ms. Spencer recently was hospitalized for chest pains, and she incurred charges for:
✑ The cost of hospitalization for two days
✑ Diagnostic tests performed in the hospital
✑ Trans

  • A. ambulance and the diagnostic tests
  • B. ambulance, the diagnostic tests, and the physician's professional services
  • C. cost of hospitalization
  • D. cost of hospitalization and the physician's professional services

Answer: D

NEW QUESTION 25

A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

  • A. the specialists in the PHO are typically compensated on a capitation basis
  • B. the specialists in the PHO are typically compensated on a capitation basis
  • C. it typically limits the number of specialists by type of specialty
  • D. it is available to a hospital's entire eligible medical staff
  • E. physician membership in the PHO is limited to PCPs

Answer: B

NEW QUESTION 26
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