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AHM-250 Exam Dumps - AHIP Certification Questions and Answers

Question # 4

John Kerry's employer has contracted to receive healthcare for its employees from the Democratic Healthcare System. Mr. Kerry visits his PCP, who sends him to have some blood tests. The PCP then refers Mr. Kerry to a specialist who hospitalizes him for on

Options:

A.

a physician practice organization

B.

a physician-hospital organization

C.

a management services organization

D.

an integrated delivery system

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Question # 5

Which of the following statements about Family and Medical Leave Act (FMLA) is WRONG?

Options:

A.

Employers need to maintain the coverage of group health insurance during this period

B.

Employees can take upto 12 weeks of unpaid leave in a 36 month period

C.

Protects people faced with birth/adoption or seriously ill family members

D.

Employers that have > 50 employees need to comply

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Question # 6

Several marketplace factors helped fuel the movement toward consumer choice. Which one of the following statements is NOT accurate with regard to these factors?

Options:

A.

After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.

B.

During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.

C.

Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.

D.

Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.

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Question # 7

Khalyn Drury's employer includes managed dental care in its employee benefits package. During open enrollment, Ms. Drury enrolled in the dental plan, which provides dental services to its members in exchange for a prepayment (the premium). Dental services

Options:

A.

dental preferred provider organization (PPO)

B.

traditional fee-for-service (FFS) dental plan

C.

plan with a dental point of service (POS) option

D.

dental health maintenance organization (DHMO)

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Question # 8

One feature of the Employee Retirement Income Security Act (ERISA) is that it:

Options:

A.

Requires self-funded employee benefit plans to pay premium taxes at the state level.

B.

Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.

C.

Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.

D.

Requires that state insurance laws apply to all employee benefit plans except insured plans.

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Question # 9

Medicare is the federal government program established under Title XVIII of the Social Security Act of 1965 to provide hospital, medical and other covered benefits to elderly and disabled persons. Medicare is available for:

Options:

A.

Persons age 63 or older.

B.

Persons with qualifying disabilities (over the age of 63)

C.

Persons with end-stage renal disease (ESRD)

D.

Low income individuals

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Question # 10

From the following choices, choose the definition that best matches the term health risk assessment (HRA)

Options:

A.

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

B.

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

C.

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

D.

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

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Question # 11

Bart Vereen is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a managed care plan. Both plans have a typical coordination of benefits (COB) provision, but neither plan has a nonduplication of benefits provision

Options:

A.

380

B.

130

C.

0

D.

550

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Question # 12

One HMO model can be described as an extension of a group model HMO because it contracts with multiple group practices, rather than with a single group practice. This HMO model is known as the

Options:

A.

staff model HMO

B.

IPA model HMO

C.

direct contract model HMO

D.

network model HMO

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Question # 13

Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

Options:

A.

Acquisition of the Leopard Health Plan by the Hickory Health Plan.

B.

Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

C.

Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

D.

Consolidation of the Carver Health Plan and the Limestone Health Plan.

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Exam Code: AHM-250
Exam Name: Healthcare Management: An Introduction
Last Update: Feb 22, 2025
Questions: 367
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