ahip ahm-250 practice test

According to the IRS, which of the following is not an allowable preventive care service?

• A. Smoking cessation programs.
• B. Periodic health examinations.
• C. Health club memberships.
• D. Immunizations for children and adults.

After a somewhat modest start in 2004, enrollment in HSA-related health plans more than tripled in
2005, making them today’s fastest growing type of CDHP. As of January 2006, enrollment in HSAs had
reached nearly:

• A. 1.2 million
• B. 2.2 million
• C. 3.2 million
• D. 4.2 million

Al Marak, a member of the Frazier Health Plan, has asked for a typical Level One appeal of a decision
that Frazier made regarding Mr. Marak's coverage. One true statement about this Level One appeal is
that

• A. Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision
• B. It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute
• C. It is considered to be an informal appeal
• D. It will be handled by an independent review organization (IRO)

All CDHP products provide federal tax advantages while allowing consumers to save money for their
healthcare.

• A. True
• B. False

Allgood Medical, Inc., a health plan, has contracted with Mercy Memorial Hospital to provide
inpatient medical services to Allgood's plan members. The terms of the contract specify that Allgood
will reimburse Mercy Memorial on the basis of a negotiated ch

• A. per diem agreement
• B. fee-for-service agreement
• C. withhold agreement
• D. diagnostic related group (DRG) agreement

Although the process is voluntary for health plans, external accreditation is becoming more and more
important as states and purchasers require health plans undergo as many states and purchasers
require health plans undergo some type of external review pr

• A. Is voluntary for health plans.
• B. Requires all change accreditation organizations to use the same standards of accreditation.
• C. Typically requires the accrediting organization to conduct a medical record review and a review of a health plan's credentialing processes, but not an evaluation of the health plans' member service systems processes.
• D. Cannot assure that a health plan meets a specified level of quality.

Amendments to the HMO act 1973 do not permit federally qualified HMO’s to use

• A. Retrospective experience rating
• B. Adjusted community rating
• C. Community rating by class
• D. Community rating

An exclusive provider organization (EPO) operates much like a PPO. However, one difference
between an EPO and a PPO is that an EPO

• A. Is regulated under federal HMO legislation
• B. Generally provides no benefits for out-of-network care
• C. Has no provider network of physicians
• D. Is not subject to state insurance laws

An HMO that combines characteristics of two or more HMO models is sometimes referred to as a

• A. Network model HMO
• B. Group model HMO
• C. Staff model HMO
• D. Mixed model HMO

Appropriateness of treatment provided is determined by developing criteria that if unmet will
prompt further investigation of a claim which are also called:

• A. Codes
• B. Lists
• C. Edits
• D. Checks