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Home AHIP AHM-250

AHIP AHM-250 Exam Practice Questions (P. 4)

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Question #31
Before the Leo Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to
  1. A
    receive compensation based on the volume and variety for medical services they perform for Leo plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services
  2. B
    have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy
  3. C
    receive from the IPA the same monthly compensation for each Leo plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees
  4. D
    receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges

Correct Answer:
C

Question #32
Beginning in the early 1980s, several factors contributed to increased demand for behavioral healthcare services. These factors included:
  1. A
    increased stress on individuals and families
  2. B
    increased availability of behavioral healthcare services
  3. C
    greater awareness and acceptance of behavioral healthcare issues
  4. D
    all of the above

Correct Answer:
D

Question #33
Bill Clinton is a member of Lewinsky's PBM plan which has a three-tier copayment structure. Bill fell ill and his doctor prescribed him AAA, a brand-name drug which was included in the Lewinsky's formulary; BBB, a non-formulary drug; and CCC, a generic drug. In which order, from most preferred to least, is the preferred drug of choice for this coverage?
  1. A
    CCC, AAA, BBB
  2. B
    BBB, CCC, AAA
  3. C
    BBB, AAA, CCC
  4. D
    CCC, BBB, AAA

Correct Answer:
A

Question #34
Brokers are one type of distribution channel that health plans use to market their health plans. One true statement about brokers for health plan products is that, typically, brokers:
  1. A
    Are not required to be licensed by the states in which they market health plans
  2. B
    Are compensated on a salary basis
  3. C
    Represent only one health plan or insurer
  4. D
    Are considered to be an agent of the buyer rather than an agent of the health plan or Insurer

Correct Answer:
D

Question #35
By definition, a health plan's network refers to the:
  1. A
    organizations and individuals involved in the consumption of healthcare provided by the plan
  2. B
    relative accessibility of the plan's providers to the plan's participants
  3. C
    group of physicians, hospitals, and other medical care providers with whom the plan has contracted to deliver medical services to its members
  4. D
    integration of the plan's participants with the plan's providers

Correct Answer:
C

Question #36
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:
  1. A
    branding
  2. B
    positioning
  3. C
    database marketing
  4. D
    personal selling

Correct Answer:
B

Question #37
By offering a comprehensive set of healthcare benefits to its members, an HMO ensures that its members obtain quality, cost-effective, and appropriate medical care. Ways that an HMO provides comprehensive care include:
  1. A
    coordinating care across a variety of benefits
  2. B
    emphasizing preventive care by covering many preventive services either in full or with a small copayment
  3. C
    offering its members access to wellness programs
  4. D
    All of the above

Correct Answer:
D

Question #38
Col. Martin Avery, on active duty in the U.S. Army, is eligible to receive healthcare benefits under one of the three TRICARE health plan options. If Col Avery elects to participate in TRICARE Prime, he will be:
  1. A
    able to obtain full benefits for services obtained from network and non-network providers
  2. B
    subject to copayment, deductible, and coinsurance requirements for any medical care he receives
  3. C
    required to formally enroll for coverage and pay an enrollment fee
  4. D
    assigned to a primary care manager who is responsible for coordinating all his care

Correct Answer:
D

Question #39
Consumer-directed health plans are not a new concept. They actually got their start in the late 1970s with the advent of:
  1. A
    Health savings accounts (HSAs)
  2. B
    Health reimbursement arrangements (HRAs)
  3. C
    Medical savings accounts (MSAs)
  4. D
    Flexible spending arrangements (FSAs)

Correct Answer:
D

Question #40
Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed-panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.
  1. A
    All members of Holcomb HMO must select Dr. Phram as their primary care physician (PCP).
  2. B
    Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.
  3. C
    Dr. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO
  4. D
    Holcomb HMO plan members may self-refer to Dr. Phram at full benefits without first obtaining a referral from their PCPs.

Correct Answer:
A

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