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Exam Code: AHM-250Exam Name: Healthcare Management: An Introduction
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AHM-250 Test Answers Total Q&A: 367 Questions and Answers
Last Update: 2015-08-24
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Exam Code: AHM-530Exam Name: Network Management
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NO.1 Utilization management techniques that most HMOs use for hospital providers include:
A. Discharge planning
B. Case management
C. Co-payment for office visits
D. A & B
Answer: A,B
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NO.2 A public employer, such as a municipality or county government would be considered which of
the following?
A. Employer-employee group
B. Multiple-employer group
C. Affinity group
D. Debtor-creditor group
Answer: A
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NO.3 Medicaid is a jointly funded federal and state program that provides hospital and medical
expense coverage to low-income individuals and certain aged and disabled individuals. One
characteristic of Medicaid is that
A. providers who care for Medicaid recipients must accept Medicaid payment as payment in full for
services rendered
B. Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all
services
C. Medicaid is always the primary payer of benefits
D. benefits offered by Medicaid programs are federally mandated and do not vary by state
Answer: A
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NO.4 The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide
A. expert consultation to end-users for solving specialized and complex healthcare problems through
the use of a knowledge-based computer system
B. a comprehensive accreditation for PPOs
C. measurements of plan performance and effectiveness that potential healthcare purchasers can use
to compare quality offered by different healthcare plans
D. a mathematical model that can predict future claim payments and premiums
Answer: C
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NO.5 Which of the following statements about the Title VII of the Civil Rights Act is WRONG?
A. Employers with more than 15 employees engaged in interstate commerce need to comply
B. Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide
coverage during childbirth and related medical conditions on the same basis as they provide coverage
for other medical conditions
C. Allows HMOs to set different policies for people from different races, religions, sex or national
origin to safeguard their interests.
D. Protects all employees
Answer: C
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NO.6 Bill the member for the balance of the fee above the maximum allowable amount under the fee
schedule reimbursement method
A. UCR fee
B. Capitation fee
C. Balance bill
D. Discounted fee-for-service
Answer: C
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NO.7 The Military Health System of the Department of Defense offers ongoing healthcare coverage
to military personnel and their families through the
A. Health Care Quality Improvement Program (HCQIP)
B. Health Plan Management System (HPMS)
C. TRICARE healthcare system
D. Health Care Prepayment Plan (HCPP)
Answer: C
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NO.8 The measures used to evaluate healthcare quality are generally divided into three categories:
process, structure, and outcomes. An example of a process measure that can be used to evaluate a
health plan's performance is the:
A. Percentage of adult plan members who receive regular medical checkups.
B. Number of plan members contracting an infection in the hospital.
C. Percentage of board certified physicians within the health plan's network.
D. Number of hospital admissions for plan members with certain medical conditions.
Answer: A
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AHIP AHM-250 : Healthcare Management: An Introduction
Exam Code: AHM-250
Exam Name: Healthcare Management: An Introduction
Version: V12.35
Updated: Sep 17, 2019
Q & A: 367 Questions and Answers
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