AHM-530 AHIP Exam Questions and Free Practice Test

Question 19

- (Topic 2)
State Medicaid agencies can contract with health plans through open contracting or selective contracting. One advantage of selective contracting is that it

A. Allows enrollees to choose from among a greater variety of health plans

B. Reduces the competition among health plans

C. Increases the ability of new, local plans to participate in Medicaid programs

D. Encourages the development of products that offer enhanced benefits and more effective approaches to health plans

Correct Answer:D

Question 20

- (Topic 1)
Health plans often negotiate compensation arrangements that transfer some or all of the financial risk associated with delivering healthcare services to network providers. The following statements are about these compensation arrangements. Select the answer choice containing the correct statement.

A. A per diem system typically places a healthcare facility at risk for controlling utilization and costs internally.

B. One likely reason that an health plan would use a fee schedule system to compensate providers is that this system transfers most of the financial risk to the provider.

C. Under a salary system, a provider assumes no service risk.

D. The use of a FFS or a salary system allows an health plan to transfer a greater proportion of financial risk to providers than does the use of capitation.

Correct Answer:A

Question 21

- (Topic 2)
The provider contract that Dr. Laura Cartier has with the Sailboat health plan includes a section known as the recitals. Dr. Cartier's contract includes the following statements:

A. A statement that identifies the purpose of the contract

B. A statement that defines in legal terms the parties to the contract

C. A statement that identifies the Sailboat products to be covered by the contractOf these statements, the ones that are likely to be included in the recitals section of D

D. Cartier's contract are statements:

E. A, B, and C

F. A and B only

G. A and C only

H. B and C only

Correct Answer:A

Question 22

- (Topic 1)
Health plans are required to follow several regulations and guidelines regarding the access and adequacy of their provider networks. The Federal Employee Health Benefits Program (FEHBP) regulations, for example, require that health plans

A. Allow members direct access to OB/GYN services

B. Allow members direct access to prescription drug services

C. Provide access to Title X family-planning clinics

D. Provide average office waiting times of no more than 30 minutes for appointments with plan providers

Correct Answer:D

Question 23

- (Topic 2)
The Enterprise Health Plan has indicated an interest in delegating its medical records review activities to the Teal Group and has forwarded a typical letter of intent to Teal. One true statement about this letter of intent is that it:

A. Is a contract that creates a legally binding relationship between Enterprise and Teal

B. Cannot include a confidentiality clause

C. Serves as a delegation agreement between Enterprise and Teal

D. Outlines the delegation oversight process

Correct Answer:D

Question 24

- (Topic 1)
The Walton Health Plan uses the fee-for-service pharmaceutical reimbursement approach known as the maximum allowable cost (MAC) method. If Walton’s MAC list specifies a cost of 8 cents per tablet for a particular drug but the participating pharmacy pays 10 cents per tablet for the drug, then Walton will be obligated to reimburse the pharmacy for

A. 8 cents per tablet, but the pharmacy can bill the subscriber for the remaining 2 cents per tablet

B. 8 cents per tablet, and the pharmacy cannot bill the subscriber for the remaining 2 cents per tablet

C. 10 cents per tablet, but the pharmacy must refund the extra 2 cents per tablet to the subscriber

D. 10 cents per tablet, and the pharmacy is not required to refund the extra 2 cents per tablet to the subscriber

Correct Answer:B

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