AHIP REAL EXAM 2024 BRANDNEW!! QUESTIONS AND CORRECT ANSWERS
ALREADY GRADED A+//BRANDNEW!!
Ms. Bushman has two homes in different states and is concerned about restrictions on where she can
get her medications. What should you tell her? - answer-Part D prescription drug plans use networks of
pharmacies within their service areas. She could look for a plan that maintains a network in both states.
Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? -
answer-Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin,
disability, age and sex.
Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an
individual's age and - answer-charge higher premiums
As a result of violations of ACA Section 1557 nondiscrimination rules, - answer-a health plan may revoke
an agent or broker's appointment with the health plan.
Which Medicare programs are covered by ACA Section 1557 under the Biden Administration's Proposed
Rule? - answer-Parts A, C, and D, and as proposed Part B.
ACA Section 1557 rules for disability concern - answer-policies and procedures, physical access, and
communication.
Which of these actions is most likely to be permitted in dealing with a person with limited English
proficiency? - answer-Allowing a child to interpret in an emergency.
Under Section 1557, the 2020 Final Rule issued during the Trump Administration sex was initially
defined____________ - answer-as biologic sex only, meaning whether a person was determined to be
male or female at birth.
Which of the following statements best describes the scope of operations subject to Section 1557 under
the Proposed Rule of the Biden Administration? - answer-Health insurers under the Biden
Administration's Proposed Rule are not considered to be principally engaged in delivering health care,
and thus lines of business that do not receive federal funding or administered under Title I of the ACA,
such as disability income insurance, do not fall under the scope of 1557.
,Which entity enforces Section 1557 for programs that receive funding from on are administered by HHS?
- answer-The Office of Civil Rights (OCR) of HHS.
Section 1557 of the Affordable Care Act applies to - answer-all health programs and activities
administered by or receiving federal financial assistance from HHS.
Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from
vision or hearing impairments, free of charge, and in a timely manner. Auxiliary aids and services include
which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software - answer-I, II, III, and IV
For a health plan, what are the possible consequences of violations of ACA Section 1557? - answer-Loss
of federal business and compensatory damages.
Loss of federal business and compensatory damages. - answer-cannot deny coverage to LEP individuals
and is required to provide language assistance to them, free of charge.
cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of
charge. - answer-Broker Mary Jones has recruited a diverse workforce. She encourages her agents to
prospect through community-based marketing and within their community of influence.
Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the
purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate
supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain
individuals. What should you do? - answer-Report the incident to the compliance department (via
compliance hotline or other mechanism)
A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a
controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160.
, You review the prescription and have concerns about possible forgery. What is your next step? -
answerCall the prescriber to verify the quantity
Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)? - answer-Deportation
Which of the following requires intent to obtain payment and the knowledge the actions are wrong? -
answer-Fraud
You are performing a regular inventory of the controlled substances in the pharmacy. You discover a
minor inventory discrepancy. What should you do? - answer-Follow your pharmacy's procedures.
You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe
Diagnostics") requested a substantial payment for a large patient group. Many of these claims are for a
certain procedure. You review the same type of procedure for other diagnostic providers and realize
Doe Diagnostics' claims far exceed any other provider you reviewed. What should you do? - answer-
Consult with your immediate supervisor for next steps or contact the compliance department (via
compliance hotline, Special Investigations Unit [SIU], or other mechanism)
Abuse involves payment for items or services when there is no legal entitlement to that payment and
the provider has not knowingly or intentionally misrepresented facts to obtain payment. - answer-True
Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which
includes Medicare) constitute fraud by the person making as well as the person receiving them. -
answer-True
Ways to report potential fraud, waste, and abuse (FWA) include:
a.Telephone hotlines
b.Mail drops
c.In-person reporting to the compliance department/supervisor
d.Reporting to a Special Investigative Units (SIUs)
e.All of the above - answer-All of the above
ALREADY GRADED A+//BRANDNEW!!
Ms. Bushman has two homes in different states and is concerned about restrictions on where she can
get her medications. What should you tell her? - answer-Part D prescription drug plans use networks of
pharmacies within their service areas. She could look for a plan that maintains a network in both states.
Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? -
answer-Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin,
disability, age and sex.
Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an
individual's age and - answer-charge higher premiums
As a result of violations of ACA Section 1557 nondiscrimination rules, - answer-a health plan may revoke
an agent or broker's appointment with the health plan.
Which Medicare programs are covered by ACA Section 1557 under the Biden Administration's Proposed
Rule? - answer-Parts A, C, and D, and as proposed Part B.
ACA Section 1557 rules for disability concern - answer-policies and procedures, physical access, and
communication.
Which of these actions is most likely to be permitted in dealing with a person with limited English
proficiency? - answer-Allowing a child to interpret in an emergency.
Under Section 1557, the 2020 Final Rule issued during the Trump Administration sex was initially
defined____________ - answer-as biologic sex only, meaning whether a person was determined to be
male or female at birth.
Which of the following statements best describes the scope of operations subject to Section 1557 under
the Proposed Rule of the Biden Administration? - answer-Health insurers under the Biden
Administration's Proposed Rule are not considered to be principally engaged in delivering health care,
and thus lines of business that do not receive federal funding or administered under Title I of the ACA,
such as disability income insurance, do not fall under the scope of 1557.
,Which entity enforces Section 1557 for programs that receive funding from on are administered by HHS?
- answer-The Office of Civil Rights (OCR) of HHS.
Section 1557 of the Affordable Care Act applies to - answer-all health programs and activities
administered by or receiving federal financial assistance from HHS.
Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from
vision or hearing impairments, free of charge, and in a timely manner. Auxiliary aids and services include
which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software - answer-I, II, III, and IV
For a health plan, what are the possible consequences of violations of ACA Section 1557? - answer-Loss
of federal business and compensatory damages.
Loss of federal business and compensatory damages. - answer-cannot deny coverage to LEP individuals
and is required to provide language assistance to them, free of charge.
cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of
charge. - answer-Broker Mary Jones has recruited a diverse workforce. She encourages her agents to
prospect through community-based marketing and within their community of influence.
Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the
purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate
supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain
individuals. What should you do? - answer-Report the incident to the compliance department (via
compliance hotline or other mechanism)
A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a
controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160.
, You review the prescription and have concerns about possible forgery. What is your next step? -
answerCall the prescriber to verify the quantity
Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)? - answer-Deportation
Which of the following requires intent to obtain payment and the knowledge the actions are wrong? -
answer-Fraud
You are performing a regular inventory of the controlled substances in the pharmacy. You discover a
minor inventory discrepancy. What should you do? - answer-Follow your pharmacy's procedures.
You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe
Diagnostics") requested a substantial payment for a large patient group. Many of these claims are for a
certain procedure. You review the same type of procedure for other diagnostic providers and realize
Doe Diagnostics' claims far exceed any other provider you reviewed. What should you do? - answer-
Consult with your immediate supervisor for next steps or contact the compliance department (via
compliance hotline, Special Investigations Unit [SIU], or other mechanism)
Abuse involves payment for items or services when there is no legal entitlement to that payment and
the provider has not knowingly or intentionally misrepresented facts to obtain payment. - answer-True
Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which
includes Medicare) constitute fraud by the person making as well as the person receiving them. -
answer-True
Ways to report potential fraud, waste, and abuse (FWA) include:
a.Telephone hotlines
b.Mail drops
c.In-person reporting to the compliance department/supervisor
d.Reporting to a Special Investigative Units (SIUs)
e.All of the above - answer-All of the above
