AHM-250 AHIP Exam Questions and Free Practice Test

Question 37

- (Topic 1)
In 1999, the United States Congress passed the Financial Services Modernization Act, referred to as the Gramm-Leach-Bliley (GLB) Act. The primary provisions included under
the GLB Act require financial institutions, including health plans, to take several

A. Notify customers of any sharing of non-public personal financial information with nonaffiliated third parties.

B. Prohibit customers from having the opportunity to 'opt-out' of sharing non-public personal financial information.

C. Disclose to affiliates, but not to third parties, their privacy policies regarding the sharing of nonpublic personal financial information.

D. Agree not to disclose personally identifiable financial information or personally identifiable health information.

Correct Answer:A

Question 38

- (Topic 1)
Federal Employee Health Benefits Program (FEHBP) requires health plans offering services to federal employees and their dependents to provide

A. Immediate access to emergency services

B. Urgent Appointments within 24 hours

C. Routine appointments once a m

D. D

E. A

F. B & C

G. All of the listed options

Correct Answer:F

Question 39

- (Topic 1)
Before an HMO contracts with a physician, the HMO first verifies the physician's credentials.
Upon becoming part of the HMO's organized system of healthcare, the physician is typically subject to

A. both recredentialing and peer review

B. recredentialing only

C. peer review only

D. neither recredentialing nor peer review

Correct Answer:C

Question 40

- (Topic 1)
In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

A. The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

B. Each insurance company selling Medigap must sell all the different Medigap policies.

C. Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

D. Medigap benefits vary by plan type (A through L), and are not uniform nationally.

Correct Answer:A

Question 41

- (Topic 1)
In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care. Such intervention can be based on the results of

A. Prospective review

B. Concurrent review

C. B and C only

D. A, B, and C

E. A and B only

F. A and C only

G. B only

Correct Answer:D

Question 42

- (Topic 3)
To determine fee reimbursements to be paid to physicians, the Triangle Health Plan assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier. Triangle and the providers negotiate the value of the

A. Diagnosis-related group (DRG) system

B. Relative value scale (RVS)

C. Partial capitation arrangement

D. Capped fee system

Correct Answer:B

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