AHIP AHM-250 Exam Questions Free Practice Test

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Questions # 41:

By definition, the marketing process of defining a certain place or market niche for a product relative to competitors and their products and then using the marketing mix to attract certain market segments is known as

Options:

branding

positioning

database marketing

personal selling

Expert Solution

Questions # 42:

Emily Brown works for Integral Health Plan and represents the company as a board member for the board of directors. Which best describes Emily's position?

Options:

Community Representative

Inside Director

Outside Director

None of these

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Questions # 43:

In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

Options:

The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

Each insurance company selling Medigap must sell all the different Medigap policies.

Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

Medigap benefits vary by plan type (A through L), and are not uniform nationally.

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Questions # 44:

Each of the following statements describes a health plan that is using a method of managing institutional utilization. Select the answer choice that describes a health plan's use of retrospective review to decrease utilization of hospital services.

Options:

The Serenity Healthcare Organization requires a plan member or the provider in charge of the member's care to obtain authorization for inpatient care before the member is admitted to the hospital.

UR nurses employed by the Friendship Health Plan monitor length of stay to identify factors that might contribute to unnecessary hospital days.

The Optimum Health Group evaluates the medical necessity and appropriateness of proposed services and intervenes, if necessary, to redirect care to a more appropriate care setting.

The Axis Medical Group examines provider practice patterns to identify areas in which services are being underused, overused, or misused and designs strategies to prevent inappropriate utilization in the future.

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Questions # 45:

According to the IRS, which of the following is not an allowable preventive care service?

Options:

Smoking cessation programs.

Periodic health examinations.

Health club memberships.

Immunizations for children and adults.

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Questions # 46:

In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

Options:

Therapeutic / always

Generic / always

Generic / never

Therapeutic / never

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Questions # 47:

A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services.

With regard to the steps that the health plan's claims e

Options:

should assume that all services requiring preauthorization have been preauthorized

should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim

need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits

need not determine whether the member is covered by another health plan that allows for coordination of benefits

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Questions # 48:

Ashley Martin is covered by a managed healthcare plan that specifies a $300 deductible and includes a 30% coinsurance provision for all healthcare obtained outside the plan’s network of providers. In 1998, Ms. Martin became ill while she was on vacation,

Options:

$300

$510

$600

$810

Expert Solution

Questions # 49:

A health plan may use one of several types of community rating methods to set premiums for a health plan. The following statements are about community rating. Select the answer choice containing the correct statement.

Options:

Standard (pure) community rating is typically used for large groups because it is the most competitive rating method for large groups.

Under standard (pure) community rating, a health plan charges all employers or other group sponsors the same dollar amount for a given level of medical benefits or health plan, without adjusting for factors such as age, gender, or experience.

In using the adjusted community rating (ACR) method, a health plan must consider the actual experience of a group in developing premium rates for that group.

The Centers for Medicare and Medicaid Services (CMS) prohibits health plans that assume Medicare risk from using the adjusted community rating (ACR) me

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Questions # 50:

If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

Options:

Transfer all of the HMO's business to other carriers.

Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.

Sell the HMO's assets in order to satisfy the HMO's obligations.

Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

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