AHIP AHM-250 PAHM Exam Practice Test Instant Access

Question 1

The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

AUnder the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency

BThe Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review

CAccording to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria

DThe Quality Assessment and Improvement Model Act exempts closed plans from implementing a quality improvement program.

Answer : A

Question 2

Maternity management programs are commonly included in?

AScreening Programs

BHealth promotion Programs

CImmunization programs

Answer : C

Question 3

Integration of provider organizations is said to occur when

APreviously separate providers combine & come under common ownership or control.

BTwo or more providers combine their business operations that they previously carried out separately.

CBoth A & B

DNone of the above

Answer : C

Question 4

Arrange the following provider organizations in the order ranging from least integrated.

I . Physician Practice Management (PPM) company

II . Integrated Delivery System (IDS)

III . Group Practice Without Walls (GPWW)

IV . Independent Practice Association (IPA)

AI, II, III, IV

BIV, III, I, II

CI, II, IV, III

DI, IV, II, III

Answer : B

Question 5

Medigap policies were standardized into ten standard benefit pl ranging from A-J by the ____

AOmnibus Budget Reconciliation Act (OBRA) of 1990

BTax Equity & Fiscal Responsibility Act (TEFRA) of 1982

CMedicare Modernization Act (MMA) of 2003

DBalanced Budget Act (BBA) of 1997

Answer : A

Question 6

Renewal underwriting involves a reevaluation of

AThe group's experience

BLevel of participation in the health plan

CBoth A and B

DNone of the Above

Answer : C

Question 7

The process of identifying and classifying the risk represented by an individual or group is called

ARating

BAnti selection

CUnderwriting

DNone of the above

Answer : C

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