AHIP AHM-250 PAHM Exam Questions Instant Access

Question 1

The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Select the answer choice containing the correct statement.

AIn most preferred provider organizations (PPOs) and open access plans, plan members must receive a referral before accessing behavioral healthcare services from a specialist.

BTo manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) typically use alternative treatment levels and alternative treatment methods rather than crisis intervention or alternative treatment settings.

CManaged behavioral health organizations (MBHOs) typically are prohibited from negotiating with network providers for reduced fees in exchange for increased patient volume.

DThe treatment approaches for behavioral healthcare most often include drug therapy, psychotherapy, and counseling.

Answer : B

Question 2

Health plans sometimes contract with independent organizations to provide specialty services, such as vision care or rehabilitation services, to plan members. Specialty services that have certain characteristics are generally good candidates for health pl

ALow or stable costs.

BAppropriate, rather than inappropriate, utilization rates.

CA benefit that cannot be easily defined.

DDefined patient population.

Answer : D

Question 3

To set up and contribute to an HSA, an individual must:

ABe covered by a high-deductible health plan that meets federal requirements.

BNot have other health insurance.

CNot be enrolled in Medicare.

DAll of the above.

Answer : D

Question 4

The following statements describe common types of physician/hospital integrated models: (A) The Alpha Company, which is owned by a group of investors, is a for-profit legal entity that buys entire physician practices, not just the tangible assets of the p

APhysician hospital organization physician practice management company

BPhysician practice management company physician hospital organization

CMedical foundation management services company

DPhysician hospital organization medical foundation

Answer : B

Question 5

The Courtland PPO maintains computerized records that include clinical, demographic, and administrative data about individual plan members. The data in these records is available to plan providers, ancillary service departments, pharmacies, and others inv

Aa data warehouse

Ba decision support system

Can outsourcing system

Dan electronic medical record (EMR) system

Answer : D

Question 6

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 7

For this question, select the answer choice containing the terms that correctly complete the blanks labeled A and B in the paragraph below.

NCQA offers Quality Compass, a national database of performance and accreditation information submitted by managed

AHealth Plan Employer Data and Information Set (HEDIS) mandatory

BHealth Plan Employer Data and Information Set (HEDIS) voluntary

CORYX mandatory

DORYX voluntary

Answer : B

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