AHIP AHM-250 PAHM Exam Practice Test Instant Access

Question 1

One factor the Sandpiper Health Plan uses to assess its quality is a clinician's bedside manner, i.e., how friendly and understanding the clinician is, whether the patient feels that the clinician listens to the patient's concerns, how well the clinical

Aa provider service quality issue

Ban administrative service quality issue a healthcare process quality issue

Ca healthcare outcomes quality issue

Da healthcare process quality issue

Answer : A

Question 2

Arthur Moyer is covered under his employer's group health plan, which must comply with the Consolidated Omnibus Budget Reconciliation Act (COBRA). Mr. Moyer is terminating his employment. He has elected to continue his coverage under his employer's group

A18 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

B18 months, even if he obtains group health coverage through another employer.

C36 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

D36 months, even if he obtains group health coverage through another employer.

Answer : A

Question 3

From the following choices, choose the definition that best matches the term Screening

AA technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

BA technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

CA technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

DA technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

Answer : B

Question 4

One characteristic of disease management programs is that they typically

Afocus on individual episodes of medical care rather than on the comprehensive care of the patient over time

Bare used to coordinate the care of members with any type of disease, either chronic or nonchronic

Cfocus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition

Duse clinical practice processes to standardize the implementation of best practices among providers

Answer : D

Question 5

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

Ashould assume that all services requiring preauthorization have been preauthorized

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

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

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

Answer : B

Question 6

Medicaid is a jointly funded federal and state program that provides hospital and medical expense coverage to low-income individuals and certain aged and disabled individuals. One characteristic of Medicaid is that

Aproviders who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered

BMedicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all services

CMedicaid is always the primary payer of benefits

Dbenefits offered by Medicaid programs are federally mandated and do not vary by state

Answer : A

Question 7

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?

ACommunity Representative

BInside Director

COutside Director

DNone of these

Answer : B

AHIP Healthcare Management: An Introduction AHM-250 PAHM Exam Practice Test