AHM-250 Free Practice Test

- (Topic 2)
Specialty services that have certain characteristics generally are good candidates for managed care approaches. These characteristics generally include that the specialty service should have

1. A. appropriate, rather than inappropriate, utilization
2. B. a defined patient population
3. C. low, stable costs
4. D. a benefit that cannot be easily defined

Correct Answer: B

- (Topic 2)
The following organizations are the primary sources of accreditation of healthcare organizations:

1. A. National Committee for Quality Assurance (NCQA)
2. B. American Accreditation HealthCare Commission/URAC Of these organizations, performance data is included i
3. C. A only
4. D. B only
5. E. A and B
6. F. none of the above

Correct Answer: A

- (Topic 2)
Managed behavioral health organizations (MBHOs) use several strategies to manage the delivery of behavioral healthcare services. The following statements are about these strategies.
Select the answer choice that contains the correct statement.

1. A. MBHOs generally provide benefits for mental health services but not for chemical dependency services.
2. B. The level of care needed to treat behavioral disorders is the same for all patients and all disorders.
3. C. By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.
4. D. PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.

Correct Answer: C

- (Topic 1)
Before the Hill Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

1. A. Receive compensation based on the volume and variety of medical services they perform for Hill plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services.
2. B. Have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy.
3. C. Receive from the IPA the same monthly compensation for each Hill plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees.
4. D. Receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges.

Correct Answer: C

- (Topic 2)
The Advantage Health Plan recently added the following features to its member services program:
1. IVR
2. Active member outreach program
3. Advantage's member services staffing needs are likely to increase as a result of

1. A. 1
2. B. 2
3. C. 1 & 2
4. D. Neither 1 nor 2

Correct Answer: B