AHM-250 AHIP Exam Questions and Free Practice Test

Question 79

- (Topic 1)
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

A. Health Plan Employer Data and Information Set (HEDIS) mandatory

B. Health Plan Employer Data and Information Set (HEDIS) voluntary

C. ORYX mandatory

D. ORYX voluntary

Correct Answer:B

Question 80

- (Topic 3)
Arrange the following provider organizations in the order ranging from least integrated.

A. Physician Practice Management (PPM) companyI

B. Integrated Delivery System (IDS)II

C. Group Practice Without Walls (GPWW)I

D. Independent Practice Association (IPA)

E. I, II, III, IV

F. IV, III, I, II

G. I, II, IV, III

H. I, IV, II, III

Correct Answer:B

Question 81

- (Topic 1)
Col. Martin Avery, on active duty in the U.S. Army, iseligibleto receive healthcare benefits under one of the three TRICARE health plan options. If Col Avery elects to participate in TRICARE Prime, he will be

A. able to obtain full benefits for services obtained from network and non-network providers

B. subject to copayment, deductible, and coinsurance requirements for any medical care he receives

C. required to formally enroll for coverage and pay an enrollment fee

D. assigned to a primary care manager who is responsible for coordinating all his care

Correct Answer:D

Question 82

- (Topic 1)
In large health plans, management functions such as provider recruiting, credentialing, contracting, provider service, and performance management for providers are typically the responsibility of the

A. chief executive officer (CEO)

B. network management director

C. board of directors

D. director of operations

Correct Answer:B

Question 83

- (Topic 2)
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:

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

Correct Answer:C

Question 84

- (Topic 1)
The following statements describe two types, or models, of HMOs:
The Quest HMO has contracted with only one multi-specialty group of physicians. These physicians are employees of the group practice, have an equity interest in the practice, and provide

A. A captive group a staff model

B. A captive group a network model

C. An independent group a network model

D. An independent group a staff model

Correct Answer:B

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