AHIP AHM-250 Exam Questions

Question 6 of 210

Phoebe Urich is covered by a traditional indemnity health insurance plan that specifies a $500 calendar-year deductible and includes a 20% coinsurance provision. When Ms. Urich was hospitalized, she incurred $3,000 in medical expenses that were covered by

1900

2000

2400

2500

Correct Answer: B

Question 7 of 210

Primary care case managers (PCCMs) provide case management services to eligible Medicaid recipients. With regard to PCCMs it is correct to say that:

PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients.

All Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs.

PCCMs receive a case management fee in addition to reimbursement for medical services on a FFS basis.

PCCMs contract directly with the federal government to provide case management services to Medicaid recipients.

Correct Answer: C

Question 8 of 210

Primary care case managers (PCCMs) provide managed healthcare services to eligible Medicaid recipients. With regard to PCCMs, it is correct to say that

PCCMs contract directly with the federal government to provide case management services to Medicaid recipients

all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs

Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients

Correct Answer: C

Question 9 of 210

Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

Acquisition of the Leopard Health Plan by the Hickory Health Plan.

Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

Consolidation of the Carver Health Plan and the Limestone Health Plan.

Correct Answer: C

Question 10 of 210

Ronald Canton is a member of the Omega MCO. He receives his nonemergency medical care from Dr. Kristen High, an internist. When Mr. Canton needed to visit a cardiologist about his irregular heartbeat, he first had to obtain a referral from Dr. High to see

Dr. High serves as the coordinator of care for the medical services that Mr. Canton receives.

Omega's network of providers includes Dr. High, but not Dr. Miller.

Omega's system allows its members open access to all of Omega's participating providers.

Omega used a financing arrangement known as a relative value scale (RVS) to compensate Dr. Miller.

Correct Answer: A