最新なAHIP AHM-250問題集（367題）、真実試験の問題を全部にカバー！

質問 1：
The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. Advances in computer technology have revolutionized the processing of medical and drug claims. Claims processing i
A. No change
B. Lower
C. Higher
D. Same
正解：C

質問 2：
The following statements are about preferred provider organizations (PPOs). Select the answer choice that contains the correct statement.
A. PPO networks may include primary care physicians and hospitals, but generally do not include specialists.
B. In a PPO, the most common method used to reimburse physicians is capitation.
C. PPOs generally pay a larger portion of a member's medical expenses when that member uses in-network providers than when the member uses out-of-network providers.
D. PPOs generally assume full financial risk for arranging medical services for their members.
正解：C

質問 3：
One feature of the Employee Retirement Income Security Act (ERISA) is that it:
A. Requires that state insurance laws apply to all employee benefit plans except insured plans.
B. Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.
C. Requires self-funded employee benefit plans to pay premium taxes at the state level.
D. Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.
正解：D

質問 4：
The following statements describe healthcare services delivered to health plan members by plan providers. Select the statement that describes a service that would most likely require utilization review and authorization.
A. Adele Farnsworth visited a dermatologist to have a mole removed from her arm.
B. Jose Redriguez, a 70-year-old Medicare patient, received a flu shot as part of his annual physical examination.
C. Corinne Maxwell underwent physical therapy after being hospitalized for hip replacement surgery.
D. Jonathan Lang underwent an electrocardiogram (EKG) during an office visit with his cardiologist.
正解：C

質問 5：
Identify the CORRECT statement(s):
(A)
Smaller the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.
(B)
Gender of the group's participants has no effect on the likelihood of loss.
A. All of the listed options
B. None of the listed options
C. B & C
D. A & C
正解：B

質問 6：
Janet Riva is covered by a traditional indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized,
she incurred $2,500 in medical expenses that were covered by her health plan.
A. $2,250
B. $1,800
C. $2,000
D. $1,750
正解：B

質問 7：
The agreement by two or more independent competitors on the prices or fees that they will charge for services is known as:
A. Horizontal group boycott
B. Horizontal division of markets
C. Price fixing
D. Tying arrangements
正解：C

質問 8：
One true statement regarding ethics and laws is that the values of a community are reflected in
A. both ethics and laws, and both ethics and laws are enforceable in the court system
B. both ethics and laws, but only laws are enforceable in the court system
C. laws only, but both ethics and laws are enforceable in the court system
D. ethics only, but only laws are enforceable in the court system
正解：B