AHIP AHM-510 Free Practice Questions

NEW QUESTION 1
States may impose nominal deductibles, coinsurance, or copayments on some Medicaid recipients for certain services. Services for which states can require copayments from Medicaid recipients include:

• A. Emergency services
• B. Family planning services
• C. Both A and B
• D. A only
• E. B only
• F. Neither A nor B

Answer: D

NEW QUESTION 2
Arthur Dace, a plan member of the Bloom Health Plan, tried repeatedly over an extended period to schedule an appointment with Dr. Pyle, his primary care physician (PCP). Mr. Dace informally surveyed other Bloom plan members and found that many people were experiencing similar problems getting an appointment with this particular provider. Mr. Dace threatened to take legal action against Bloom, alleging that the health plan had deliberately allowed a large number of patients to select Dr. Pyle as their PCP, thus making it difficult for patients to make appointments with Dr. Pyle.
Bloom recommended, and Mr. Dace agreed to use, an alternative dispute resolution (ADR)
method that is quicker and less expensive than litigation. Under this ADR method, both Bloom and Mr. Dace presented their evidence to a panel of medical and legal experts, who issued a decision that Bloom's utilization management practices in this case did not constitute a form of abuse. The panel's decision is legally binding on both parties.
This information indicates that Bloom resolved its dispute with Mr. Dace by using an ADR method known as:

• A. Corporate risk management
• B. An ombudsman program
• C. An ethics committee
• D. Arbitration

Answer: D

NEW QUESTION 3
The Sawgrass Health Center is an institution that trains healthcare professionals and performs various clinical and other types of healthcare-related research. Because Sawgrass receives government funding, it is required to provide medical care for the poor. Of the following types of health plans, Sawgrass can best be described as:

• A. A medical foundation
• B. An academic medical center (AMC)
• C. A healthcare cooperative
• D. A community health center (CHC)

Answer: B

NEW QUESTION 4
Arthur Dace, a plan member of the Bloom health plan, tried repeatedly over an extended period to schedule an appointment with Dr. Pyle, his primary care physician (PCP). Mr. Dace informally surveyed other Bloom plan members and found that many people were experiencing similar problems getting an appointment with this particular provider. Mr. Dace threatened to take legal action against Bloom, alleging that the health plan had deliberately allowed a large number of patients to select Dr. Pyle as their PCP, thus making it difficult for patients to make appointments with Dr. Pyle.
Bloom recommended, and Mr. Dace agreed to use, an alternative dispute resolution (ADR)
method that is quicker and less expensive than litigation. Under this ADR method, both Bloom and Mr. Dace presented their evidence to a panel of medical and legal experts, who issued a decision that Bloom's utilization management practices in this case did not constitute a form of abuse. The panel's decision is legally binding on both parties.
Different types of compensation arrangements in managed care plans, from fee-for-service (FFS) arrangements to capitation arrangements, lead to different types of fraud and abuse. From the answer choices below, select the response that identifies the form of abuse in which Bloom is allegedly engaging, according to Mr. Dace's complaint, and whether this form of abuse is more likely to occur in FFS compensation arrangements or in capitation arrangements.

• A. Type of abuse underutilizationType of compensation arrangement FFS arrangement
• B. Type of abuse underutilizationType of compensation arrangement capitation arrangement
• C. Type of abuse overutilizationType of compensation arrangement FFS arrangement
• D. Type of abuse overutilizationType of compensation arrangement capitation arrangement

Answer: B

NEW QUESTION 5
One typical difference between a for-profit health plan's board of directors and a not-for-profit health plan's board of directors is that the directors in a for-profit health plan

• A. Can serve on the board for a period of no more than ten years, whereas the terms of service fora not-for-profit board's directors are usually unlimited by the director's age or by a preset maximum number of years of service
• B. Must participate in raising capital for the health plan, whereas a not-for-profit board's directors are prohibited from participating directly in raising capital for the health plan
• C. Are directly accountable to shareholders, whereas a not-for-profit board's directors are accountable to plan members and the community
• D. Are not compensated for board participation, whereas a not-for-profit board's directors are compensated for board participation

Answer: C

NEW QUESTION 6
In 1994, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) revised their 1993 healthcare-specific antitrust guidelines to include analytical principles relating to multiprovider networks. Under the new guidelines, the regulatory agencies will use the rule of reason to analyze joint pricing activities by competitors in physician or multiprovider networks only if

• A. Provider integration under the network is likely to produce significant efficiencies that benefit consumers
• B. The providers in a network share substantial financial risk
• C. The combining of providers into a joint venture enables the providers to offer a new product
• D. All of the above

Answer: A

NEW QUESTION 7
The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.
Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that produce unrelated products and services. Tidewater remains an independent corporation and continues to own Diversified and the subsidiaries. In order to create and maintain a common vision and goals among the subsidiaries, the management of Diversified makes decisions about strategic planning and budgeting for each of the businesses.
By combining under Diversified a group of businesses that produce unrelated products and by consolidating the management of the businesses, Tidewater has achieved the type(s) of integration known as

• A. Conglomerate integration and operational integration
• B. Horizontal integration and operational integration
• C. Horizontal integration and virtual integration
• D. Conglomerate integration only

Answer: A

NEW QUESTION 8
Certificate of need (CON) laws apply to health plans in a variety of ways, depending upon the state. By definition, CON laws are laws that are designed to

• A. Regulate the construction, renovation, and acquisition of healthcare facilities as well as the purchase of major medical equipment in a geographical area
• B. Protect commerce from unlawful restraint of trade, price discrimination, price fixing, reduced competition, and monopolies
• C. Determine benefit payments when a person is covered by more than one plan, such as two group health plans
• D. License and regulate health plans that wish to establish and operate an HMO

Answer: A

NEW QUESTION 9
In developing its corporate strategies, the Haven Health Plan decided to implement a growth strategy that is focused on increasing the percentage of preventive health office visits from its current plan members. To accomplish this objective, Haven will send a direct mail kit to existing plan members to remind them of the variety of preventive health services that Haven currently offers, including physical exams, cholesterol tests, and mammograms. This information illustrates Haven's use of

• A. An intensive growth strategy known as market penetration
• B. An integrated growth strategy known as product development
• C. An integrated growth strategy known as market development
• D. A diversified growth strategy known as market penetration

Answer: A

NEW QUESTION 10
Nightingale Health Systems, a health plan, operates in a state that requires health plans to allow enrollees to visit obstetricians and gynecologists without a referral from a primary care provider. This information indicates that Nightingale must comply with a type of mandate known as a:

• A. Direct access law
• B. Scope-of-practice law
• C. Provider contracting mandate
• D. Physician incentive law

Answer: A

NEW QUESTION 11
Determine whether the following statement is true or false:
Failing to adopt and implement standards for the prompt investigation and settlement of claims is an example of an activity that would be considered an improper claims practice according to the NAIC Model Unfair Claims Settlement Practices Act.

• A. True
• B. False

Answer: A

NEW QUESTION 12
The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.
Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that produce unrelated products and services. Tidewater remains an independent corporation and continues to own Diversified and the subsidiaries. In order to create and maintain a common vision and goals among the subsidiaries, the management of Diversified makes decisions about strategic planning and budgeting for each of the businesses.
In order to become the type of company that is owned by people who purchase shares of the company's stock, Tidewater must undergo a process known as

• A. management buy-out
• B. piercing the corporate veil
• C. demutualization
• D. mutualization

Answer: C

NEW QUESTION 13
There are several approaches to the interagency division of responsibility for managed care entity (MCE) oversight. In State M, the state Medicaid agency, the state department of health, and the state insurance department are all responsible for ensuring that quality improvement programs are in place among the same group of MCEs and that these programs meet each agency's rules and regulations for such programs. This information indicates that State M uses the approach known as the

• A. Parallel model
• B. Shared model
• C. Concurrent model
• D. PACE model

Answer: C

NEW QUESTION 14
After conducting a business portfolio analysis, the Acorn Health Plan decided to pursue a harvest strategy with one of its strategic business units (SBUs)-Guest Behavioral Healthcare. By following a harvest strategy with Guest, Acorn most likely is seeking to

• A. Maximize Guest's short-term earnings and cash flow
• B. Increase Guest's market share
• C. Maintain Guest's market position
• D. Sacrifice immediate earnings in order to fund Guest's growth

Answer: A

NEW QUESTION 15
TRICARE, a military healthcare program, offers eligible beneficiaries three options for healthcare services: TRICARE Prime, TRICARE Extra, and TRICARE Standard. With respect to plan features, both an annual deductible and claims filing requirements must be met, regardless of whether care is delivered by network providers, under

• A. TRICARE Prime and TRICARE Extra only
• B. TRICARE Extra and TRICARE Standard only
• C. TRICARE Standard only
• D. None of these healthcare options

Answer: C

NEW QUESTION 16
State X issued a nonresident license to Tamara Pensky, a sales representative of the Verity Health Plan. In doing so, State X imposed a countersignature requirement, which requires that

• A. An officer of Verity sign a written statement which indicates that Verity appoints M
• B. Pensky as an agent who is authorized to market Verity's products
• C. An officer of Verity sign a written statement which certifies that Verity has investigated M
• D. Pensky's qualifications and background and believes she is trustworthy and competent
• E. Applications solicited by M
• F. Pensky must be signed by an individual who holds a resident License
• G. Applications solicited by M
• H. Pensky must be signed by an officer of Verity

Answer: C

NEW QUESTION 17
The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.
With regard to the state in which Tidewater is domiciled, it is correct to say that, from the perspective of both Ontario and Manitoba, Tidewater is considered to be the type of corporation known as:

• A. A foreign corporation
• B. An alien corporation
• C. A sister corporation
• D. A domestic corporation

Answer: B

NEW QUESTION 18
In the paragraph below, a statement contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.
One type of acquisition is called a stock purchase. In a typical stock purchase, a company acquires (51% / 100%) of the voting shares of another company's stock, thereby making the acquired company a subsidiary. The (acquired / acquiring) company holds all of the assets and liabilities of the acquired company.

• A. 51% / acquired
• B. 51% / acquiring
• C. 100% / acquired
• D. 100% / acquiring

Answer: C

NEW QUESTION 19
While traditional workers' compensation laws have restricted the use of managed care techniques, many states now allow managed workers' compensation. One common characteristic of managed workers' compensation plans is that they

• A. Discourage injured employees from returning to work until they are able to assume all the duties of their jobs
• B. Use low copayments to encourage employees to choose preferred providers
• C. Cover an employee's medical costs, but they do not provide coverage for lost wages
• D. Rely on total disability management to control indemnity benefits

Answer: D

NEW QUESTION 20
The National Association of Insurance Commissioners (NAIC) adopted the Health Maintenance Organization Model Act (HMO Model Act) to regulate the development and operations of HMOs. One true statement regarding the HMO Model Act is that the act

• A. includes mental health services in its definition of basic healthcare services
• B. authorizes only one state agency-the department of insurance-to regulate HMOs
• C. requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired
• D. requires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members

Answer: C

NEW QUESTION 21
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