AHM-250 AHIP Exam Questions and Free Practice Test

Question 55

- (Topic 1)
General HMO is building a provider network and is considering Universal Hospital as an addition to its network. Minimum requirements that General should consider in determining whether Universal is qualified to participate in General's network include A.

A. Both A and B

B. A only

C. B only

D. Neither A nor B

Correct Answer:A

Question 56

- (Topic 3)
The process of identifying and classifying the risk represented by an individual or group is called

A. Rating

B. Anti selection

C. Underwriting

D. None of the above

Correct Answer:C

Question 57

- (Topic 1)
Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed- panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.

A. All members of Holcomb HMO must select D

B. Phram as their primary care physician (PCP).

C. Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.

D. D

E. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO

F. Holcomb HMO plan members may self-refer to D

G. Phram at full benefits without first obtaining a referral from their PCPs.

Correct Answer:A

Question 58

- (Topic 2)
Medicare Advantage product options include:

A. Coordinated care plans, medical savings accounts and national PPOs.

B. Private Fee for Service plans, health care prepayment plans and medical savings accounts

C. Coordinated care plans, regional PPOs and private fee for service plans

D. Cost contracts, coordinated care programs and medical savings accounts.

Correct Answer:C

Question 59

- (Topic 1)
A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

A. the specialists in the PHO are typically compensated on a capitation basis

B. the specialists in the PHO are typically compensated on a capitation basis

C. it typically limits the number of specialists by type of specialty

D. it is available to a hospital's entire eligible medical staff

E. physician membership in the PHO is limited to PCPs

Correct Answer:B

Question 60

- (Topic 3)
The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

A. Both A and B

B. A only

C. B only

D. Neither A nor B

Correct Answer:A

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