AHIP AHM-250 PAHM Exam Questions Instant Access

Question 1

The following types of CDHPs allow federal tax advantages including the ability to roll funds from one year to the next:

AMSAs, HRAs, HSAs

BFSAs, MRAs, HRAs

CFSAs, HRAs, HSAs

DFSAs, MRAs HSAs

Answer : A

Question 2

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.

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

BUnder 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.

CIn 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.

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

Answer : B

Question 3

Pharmacy benefit management (PBM) companies typically interact with physicians and pharmacists by performing such clinical services as physician profiling. Physician profiling from a PBM's point of view involves

Aascertaining that physicians in the plan have the necessary and appropriate credentials to prescribe medications

Bcompiling data on physician prescribing patterns and comparing physicians' actual prescribing patterns to expected patterns within select drug categories

Cmonitoring patient-specific drug problems through concurrent and retrospective review

Destablishing protocols that require physicians to obtain certification of medical necessity prior to drug dispensing

Answer : B

Question 4

If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

AA Level One appeal, and the member has the right to a further appeal

BA Level Two appeal, and the reviewer's decision is final and binding

CAn independent external appeal, and the member has the right to a further appeal

DArbitration, and the reviewer's decision is final and binding

Answer : A

Question 5

Which of the following is NOT a reason for conducting utilization reviews?

AImprove the quality and cost effectiveness of patient care

BReduce unnecessary practice variations

CMake appropriate authorization decisions

DAccommodate special requirements of inpatient care

Answer : D

Question 6

A health plan's ability to establish an effective provider network depends on the characteristics of the proposed service area and the needs of proposed plan members. It is generally correct to say that

Ahealth plans have more contracting options if providers are affiliated with single entities than if providers are affiliated with multiple entities

Burban areas offer more flexibility in provider contracting than do rural areas

Cconsumers and purchasers in markets with little health plan activity are likely to be more receptive to HMOs than to loosely managed plans such as PPOs

Dlarge employers tend to adopt health plans more slowly than do small companies

Answer : B

Question 7

In order to measure the expenses of institutional utilization, Holt Healthcare Group uses the standard formula to calculate hospital bed days per 1,000 plan members per year. On October 23, Holt used the following information to calculate the bed days per

A278

B397

C403

D920

Answer : B

AHIP Healthcare Management: An Introduction AHM-250 PAHM Exam Questions