AHM-250 Exam Dumps - AHIP Certification Questions and Answers

JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three

A only

Neither A nor B

Both A and B

B only

Adele Farnsworth visited a dermatologist to have a mole removed from her arm.

Jonathan Lang underwent an electrocardiogram (EKG) during an office visit with his cardiologist.

Corinne Maxwell underwent physical therapy after being hospitalized for hip replacement surgery.

Jose Redriguez, a 70-year-old Medicare patient, received a flu shot as part of his annual physical examination.

is a performance-measurement tool designed to help healthcare purchasers and consumers compare quality offered by different plans.

divides performance measures into 8 domains, and organizes reporting measures under these domains.

is updated annually and measures are changed or new measures added.

all of the above

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

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

A 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

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

Employees of the HMO

Employees of a group practice that has contracted with the HMO

Compensated primarily through capitation

Limited to primary care physicians (PCPs)

he can receive coverage for pharmaceuticals only if they are on the PBM plan's preferred list of drugs

he must receive all of his pharmaceuticals from a mail-order pharmacy program

he can receive coverage for pharmaceuticals that are on the PBM plan's preferred list of drugs, as well as for pharmaceuticals that are not on the preferred list

the PBM plan cannot receive a rebate on any pharmaceuticals it obtains from the pharmaceutical facture

The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.

The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.

The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.

The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.

Individuals enrolled in a MA plan must enroll in a stand-alone Part D prescription drug plan.

Individuals enrolled in a MA plan do not have to be eligible for Medicare Part A

Individuals enrolled in an MSA plan or a PFFS plan without Medicare drug coverage can enroll in Medicare Part D.

Individuals can enroll in MA plan in multiple regions.

should assume that all services requiring preauthorization have been preauthorized

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

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

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

True

False