AHM-250 Free Practice Test

- (Topic 1)
Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billi

1. A. prevent D
2. B. Ware from requiring a Riverside member to pay any coinsurance, copayment, or deductibles that the member would normally pay under Riverside's plan
3. C. require D
4. D. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts
5. E. prevent D
6. F. Ware from seeking compensation from patients if Riverside fails to compensate him because of the MCO's insolvency
7. G. prevent D
8. H. Ware from billing a Riverside member for medical services that are not included in Riverside's plan

Correct Answer: B

- (Topic 2)
The following programs are typically included in TRICARE medical management efforts:

1. A. Utilization management
2. B. Self-care
3. C. Case management
4. D. A and B only
5. E. A and C only
6. F. All of the listed options
7. G. B and C only

Correct Answer: C

- (Topic 3)
The following statements are about health information networks (HINs). Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement.

1. A. Most HINs are built on proprietary computer networks rather than being Internet based.
2. B. While a HIN is for the exclusive use of one organization, a community health information network (CHIN) is shared by several organizations.
3. C. A health plan can use a secured extranet design or a distributed database approach for its HIN.
4. D. HINs have the potential to increase the quality of medical care because they make a patient's medical history readily available to each provider at the point of service.

Correct Answer: A

- (Topic 3)
The feature that formed the foundation of Health Maintenance Act of 1973

1. A. Federal Qualification Requirements
2. B. Exemption from state laws
3. C. All of the above

Correct Answer: C

- (Topic 1)
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

1. A. Is voluntary for health plans.
2. B. Requires all change accreditation organizations to use the same standards of accreditation.
3. 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.
4. D. Cannot assure that a health plan meets a specified level of quality.

Correct Answer: A