AHIP AHM-250 PAHM Exam Practice Test Instant Access

Question 1

The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.

According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

A$60

B$80

C$120

D$160

Answer : B

Question 2

Prescription drug benefits in Medicare can be obtained through:

AStand alone prescription drug pl (PDPs)

BTraditional fee for service (FFS) Medicare

CMedicare Advantage pl

DBoth A & C

Answer : A

Question 3

Keith Murray is a 45 year old chartered accountant & is employed in Livingstone consultancy firm. He has been paying payroll taxes for the past 15 years. Which of the following statements is true regarding Medicare Part A entitlement?

AKeith shall be entitled to Part A benefits when he attains 65 years of age

BKeith's wife shall be entitled to Part A benefits when she attains 65 years of age

CKeith's wife shall be required to pay a monthly premium in order to receive Medicare Part A benefits

DBoth a & b

Answer : D

Question 4

In Order to act as a TPA an organization must

AEstablish written procedures for adverse determinations and appeals

BObtain a certificate of authority from the state insurance department

CDesignating the organization as a TPA

DAll of the above

Answer : B

Question 5

The process of identifying and classifying the risk represented by an individual or group is called

ARating

BAnti selection

CUnderwriting

DNone of the above

Answer : C

Question 6

Exclusive provider organizations (EPO) is similar and operates like a PPO in administration, structure but however in an EPO an out-of-network care is

APartially Covered

BCovered with more out of pocket

CNot covered

Answer : C

Question 7

Utilization management techniques that most HMOs use for hospital providers include:

ADischarge planning

BCase management

CCo-payment for office visits

DA & B

Answer : A, B

AHIP AHM-250 Healthcare Management: An Introduction PAHM Exam Practice Test