Pass the AHIP AHIP Certification AHM-250 Questions and answers with CertsForce

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Viewing questions 101-110 out of questions
Questions # 101:

Salient features of a Health Savings Account include all of the following except

Options:

A.

Funding by both employer & the employee


B.

Employer account ownership


C.

Account portability & roll over of funds from year to year


D.

Investment opportunities


Expert Solution
Questions # 102:

The following statements pertain to the federal requirements for minimum deductible & maximum out of pocket expeses for a high deductible health plan in the year 2006. Select the correct answer from the options given below.

Options:

A.

Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses- $ 2,100 for self only coverage


B.

Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses- $ 10.500 for family coverage


C.

Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses- $ 10,500 for self only coverage


D.

Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses- $ 5,250 for self only coverage


Expert Solution
Questions # 103:

Utilization management techniques that most HMOs use for hospital providers include:

Options:

A.

Discharge planning


B.

Case management


C.

Co-payment for office visits


D.

A & B


Expert Solution
Questions # 104:

The Internal Revenue Service has ruled that an HDHP coupled with an HSA may cover certain types of preventive care without a deductible or with a lower amount than the annual deductible applicable to all other services. According to IRS guidance, which on

Options:

A.

Immunizations for children and adults


B.

Tests and diagnostic procedures ordered with routine examinations


C.

Smoking cessation programs


D.

Gastric bypass surgery for obesity


Expert Solution
Questions # 105:

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.

$140


B.

$170


C.

$180


D.

$210


Expert Solution
Questions # 106:

The following statement(s) can correctly be made about the Joint Commission on Accreditation of Healthcare Organizations (JCAHO):

Options:

A.

JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three


B.

A only


C.

Neither A nor B


D.

Both A and B


E.

B only


Expert Solution
Questions # 107:

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

Options:

A.

Anti selection refers to the fact that individuals who believe that they have a less-than-average likelihood of loss tend to seek healthcare coverage to a greater extent than do individuals who believe that they have an average or greater-than-average like


B.

Federally qualified HMOs are required to medically underwrite all groups applying for coverage.


C.

Typically, a health plan guarantees the premium rate for a group health contract for a period of five years.


D.

When evaluating the risk for a group policy, underwriters typically focus on such factors as the size of the group, the stability of the group, and the activities of the group.


Expert Solution
Questions # 108:

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 ______________.

Options:

A.

Coding error


B.

Overcharging


C.

Upcoming


D.

Unbundling


Expert Solution
Questions # 109:

Which of the following features differentiates a 'Clinic without walls1 from a consolidated medical group?

Options:

A.

Unlike a consolidated medical group, physicians in a 'Clinic without walls' maintain their practices independently in multiple locations.


B.

Unlike a consolidated medical group, a 'Clinic without walls' performs or arranges for business operations for the member physicians.


C.

Both A & B


Expert Solution
Questions # 110:

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

Options:

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.


Expert Solution
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