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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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# of Questions views:	67537
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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...

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