AHM-250 Free Practice Test

- (Topic 2)
Natalie Chan is a member of the Ultra Health Plan. Whenever she needs non-emergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a
specialist, so she saw Dr. Craig when she experienced headaches. Dr. Craig referred h

1. A. Within Ultra's system, M
2. B. Chan received primary care from both D
3. C. Craig and D
4. D. Lee.
5. E. Ultra's system allows its members open access to all of Ultra's participating providers.
6. F. Within Ultra's system, D
7. G. Craig serves as a coordinator of care or gatekeeper for the medical services that M
8. H. Chan receives.
9. I. Ultra's network of providers includes D
10. J. Craig and D
11. K. Lee but not Arrow Hospital.

Correct Answer: C

- (Topic 3)
To determine fee reimbursements to be paid to physicians, the Triangle Health Plan assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier. Triangle and the providers negotiate the value of the

1. A. Diagnosis-related group (DRG) system
2. B. Relative value scale (RVS)
3. C. Partial capitation arrangement
4. D. Capped fee system

Correct Answer: B

- (Topic 2)
The Cleopatra Group, a third-party administrator (TPA), has entered into a TPA agreement with the Alexander MCO with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. On

1. A. hold all funds it receives on behalf of Alexander in trust
2. B. assume full responsibility for determining the claim payment procedures for the plan
3. C. assume full responsibility for ensuring that the health plan is administered properly
4. D. obtain from the federal government a certificate of authority designating the Cleopatra Group as a TPA

Correct Answer: A

- (Topic 1)
From the following choices, choose the definition that best matches the term health risk assessment (HRA)

1. A. A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves
2. B. A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem
3. C. A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries
4. D. A technique used to evaluate the medical necessity, appropriateness, and cost- effectiveness of healthcare services for a given patient

Correct Answer: C

- (Topic 3)
The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

1. A. An indemnity wraparound plan
2. B. A self-funded plan
3. C. An aggregate stop-loss plan
4. D. A fully funded plan

Correct Answer: D