AHM-250 Free Practice Test

- (Topic 3)
The statements below describe technology used by two health plans to respond to incoming telephone calls:
✑ The Manor Health Plan uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond t

1. A. Manor's system is best described as an automated call distributor (ACD).
2. B. Both Manor's system and Squire's device are applications of computer/telephone integration (CTI).
3. C. Squire's device is best described as an interactive voice response (IVR) system.
4. D. All of these statements are correct.

Correct Answer: B

- (Topic 3)
The nature of the claims function within health plans varies by type of plan and by the compensation arrangement that the plan has made with its providers. For example, it is generally correct to say that, in a

1. A. Preferred provider organization (PPO), the
2. B. Both A and B
3. C. A only
4. D. B only
5. E. Neither A nor B

Correct Answer: A

- (Topic 3)
Each time a patient visits a provider he has to pay a fixed dollar amount?

1. A. Deductible
2. B. Copayment
3. C. Capitation
4. D. Co-insurance

Correct Answer: B

- (Topic 1)
Before an HMO contracts with a physician, the HMO first verifies the physician's credentials.
Upon becoming part of the HMO's organized system of healthcare, the physician is typically subject to

1. A. both recredentialing and peer review
2. B. recredentialing only
3. C. peer review only
4. D. neither recredentialing nor peer review

Correct Answer: C

- (Topic 2)
PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, t

1. A. fee-for-service arrangement
2. B. risk sharing contract
3. C. capitation contract
4. D. rebate contract

Correct Answer: B