AHM-250 AHIP Exam Questions and Free Practice Test

Question 31

- (Topic 2)
One typical characteristic of an integrated delivery system (IDS) is that an IDS.

A. Is more highly integrated structurally than it is operationally.

B. Provides a full range of healthcare services, including physician services, hospital services, and ancillary services.

C. Cannot negotiate directly with health plans, plan sponsors, or other healthcare purchasers.

D. Performs a single business function, such as negotiating with health plans on behalf of all of the member providers.

Correct Answer:B

Question 32

- (Topic 3)
The contract between an employer and an insurer or other TPA is called

A. Claims

B. Bond

C. ASO

D. None of the above

Correct Answer:C

Question 33

- (Topic 3)
The process of calculating the appropriate premium to charge purchasers, given the degree of risk represented by the individual or group, the expected costs to deliver medical services, and the expected marketability and competitiveness of the health plan

A. financing

B. rating

C. underwriting

D. budgeting

Correct Answer:B

Question 34

- (Topic 2)
Some providers use electronic medical records (EMRs) to document their patients' care in
an electronic form. The following statement(s) can correctly be made about EMRs:

A. EMRs are computerized records of a patient's clinical, demographic, and administrator

B. B only

C. Both A and B

D. Neither A nor B

E. A only

Correct Answer:D

Question 35

- (Topic 1)
Ed O'Brien has both Medicare Part A and Part B coverage. He also has coverage under a PBM plan that uses a closed formulary to manage the cost and use of pharmaceuticals. Recently, Mr. O'Brien was hospitalized for an aneurysm. Later, he was transferred by

A. Confinement in the extended-care facility after his hospitalization.

B. Transportation by ambulance from the hospital to the extended-care facility.

C. Physicians' professional services while he was hospitalized.

D. physicians' professional services while he was at the extended-care facility.

Correct Answer:A

Question 36

- (Topic 1)
In claims administration terminology, a claims investigation is correctly defined as the process of

A. reporting management information about services provided each time a patient visits a provider for purposes of analyzing utilization and provider practice patterns

B. obtaining all the information necessary to determine the appropriate amount to pay on a given claim

C. routinely reviewing and processing a claim for either payment or denial

D. assigning to each diagnosis or treatment reported on a claim special codes that briefly and specifically describe each diagnosis and treatment

Correct Answer:B

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