AHM-250 Free Practice Test

- (Topic 1)
Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr. Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

1. A. a traditional HMO plan
2. B. a managed indemnity plan
3. C. a point of service (POS) option
4. D. an exclusive provider organization (EPO)

Correct Answer: C

- (Topic 2)
Pharmacy benefit management (PBM) companies typically interact with physicians and pharmacists by performing such clinical services as physician profiling. Physician profiling from a PBM's point of view involves

1. A. ascertaining that physicians in the plan have the necessary and appropriate credentials to prescribe medications
2. B. compiling data on physician prescribing patterns and comparing physicians' actual prescribing patterns to expected patterns within select drug categories
3. C. monitoring patient-specific drug problems through concurrent and retrospective review
4. D. establishing protocols that require physicians to obtain certification of medical necessity prior to drug dispensing

Correct Answer: B

- (Topic 1)
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 e

1. A. should assume that all services requiring preauthorization have been preauthorized
2. B. 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
3. C. 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
4. D. need not determine whether the member is covered by another health plan that allows for coordination of benefits

Correct Answer: B

- (Topic 3)
Which of the following statements about the Title VII of the Civil Rights Act is WRONG?

1. A. Employers with more than 15 employees engaged in interstate commerce need to comply
2. 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
3. C. Allows HMOs to set different policies for people from different races, religions, sex or national origin to safeguard their interests.
4. D. Protects all employees

Correct Answer: C

- (Topic 3)
The parties to the contractual relationship that provides Castle's group health coverage to Knoll employees are

1. A. Castle and Knoll only
2. B. Knoll and all covered Knoll employees only
3. C. Castle, Knoll, and all covered Knoll employees
4. D. Castle and all covered Knoll employees only

Correct Answer: A