AHIP AHM-250 Exam Questions

Question 6 of 363

A health savings account must be coupled with an HDHP that meets federal requirements for minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for inflation. For 2006, the annual deductible for self-only coverage must

$525

$1,050

$2,100

$5,250

Correct Answer: B

Question 7 of 363

A medical foundation is a not-for-profit entity that purchases and manages physician practices. In order to retain its not-for-profit status, a medical foundation must

Provide significant benefit to the community

Employ, rather than contract with, participating physicians

Achieve economies of scale through facility consolidation and practice management

Refrain from the corporate practice of medicine

Correct Answer: A

Question 8 of 363

A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services. With regard to the steps that the health plan's claims enforcement policy, clients:

should assume that all services requiring preauthorization have been preauthorized

should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim

need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits

need not determine whether the member is covered by another health plan that allows for coordination of benefits

Correct Answer: B

Question 9 of 363

A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

the specialists in the PHO are typically compensated on a capitation basis

it typically limits the number of specialists by type of specialty

it is available to a hospital's entire eligible medical staff

physician membership in the PHO is limited to PCPs

Correct Answer: B

Question 10 of 363

A public employer, such as a municipality or county government would be considered which of the following?

Employer-employee group

Multiple-employer group

Affinity group

Debtor-creditor group

Correct Answer: A