AHM-250 AHIP Exam Questions and Free Practice Test

Question 49

- (Topic 3)
Traditional Medicare includes two parts: Medicare Part A and Medicare Part B. With regard to the ways these parts differ from each other, it is correct to say that Medicare Part A

A. provides benefits for physicians' professional services, whereas Medicare Part B provides basic hospitalization insurance

B. is financed through premiums paid by covered persons and from the federal government's general tax revenues, whereas Medicare Part B is funded primarily through a payroll tax imposed on employers and workers

C. provides 100% coverage for eligible medical expenses, whereas Medicare Part B includes annual deductible and coinsurance provisions

D. is provided automatically to most eligible persons, whereas Medicare Part B is a voluntary program

Correct Answer:D

Question 50

- (Topic 2)
One factor the Sandpiper Health Plan uses to assess its quality is a clinician's bedside manner, i.e., how friendly and understanding the clinician is, whether the patient feels that the clinician listens to the patient's concerns, how well the clinical

A. a provider service quality issue

B. an administrative service quality issue a healthcare process quality issue

C. a healthcare outcomes quality issue

D. a healthcare process quality issue

Correct Answer:A

Question 51

- (Topic 3)
In Order to act as a TPA an organization must

A. Establish written procedures for adverse determinations and appeals

B. Obtain a certificate of authority from the state insurance department

C. Designating the organization as a TPA

D. All of the above

Correct Answer:B

Question 52

- (Topic 3)
Using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider is called

A. Coding error

B. Overcharging

C. Upcoming

D. Unbundling

Correct Answer:C

Question 53

- (Topic 3)
The Stateside Health Plan uses the following outcomes measures to evaluate the quality of its diabetes disease management program.
Measure A: Incidence of foot ulcers among long-term diabetes patients Measure B: Ability of long-term diabetes patients to m

A. Measure A clinical status Measure B patient perception

B. Measure A clinical status Measure B functional status

C. Measure A functional status Measure B patient perception

D. Measure A functional status Measure B clinical status

Correct Answer:B

Question 54

- (Topic 3)
The Neptune Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot afford to pay for the care by themselves or who receive services at reduced rates because they are covered under govern me

A. cost shifting

B. Anti selection

C. receivership

D. Underwriting

Correct Answer:A

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