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Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Questions 91

Amendments to the HMO act 1973 do not permit federally qualified HMO’s to use

Options:

A.

Retrospective experience rating

B.

Adjusted community rating

C.

Community rating by class

D.

Community rating

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Questions 92

A common physician-only integrated model is a group practice without walls (GPWW). One characteristic of a typical GPWW is that the

Options:

A.

GPWW combines multiple independent physician practices under one umbrella organization

B.

GPWW generally has a lesser degree of integration than does an IPA

C.

member physicians cannot own the GPWW

D.

GPWW's member physicians must perform their own business operations

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Questions 93

From the following answer choices, choose the description of the ethical principle that best corresponds to the term Autonomy

Options:

A.

Health plans and their providers are obligated not to harm their members

B.

Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

C.

Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members

D.

Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives

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Questions 94

One of the most influential pieces of legislation in the advancement of health plans within the United States was the Health Maintenance Organization (HMO) Act of 1973. One of the provisions of the Act was that it

Options:

A.

exempted HMOs from all state licensure requirements.

B.

required all employers that offered healthcare coverage to their employees to offer only one type of federally qualified HMO.

C.

eliminated funding that supported the planning and start-up phases of new HMOs.

D.

established a process by which HMOs could obtain federal qualification

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Questions 95

Phillip Tsai is insured by both a indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of benefits p

Options:

A.

$0

B.

$300

C.

$400

D.

$900

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Questions 96

The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

Options:

A.

Has ever participated in any quality improvement activities.

B.

Is a participating provider in a health plan that will compete with Ark in its new service area.

C.

Meets the requirements of the Ethics in Patient Referrals Act.

D.

Has had a medical malpractice claim filed or other disciplinary actions taken against her.

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Questions 97

One characteristic of disease management programs is that they typically

Options:

A.

focus on individual episodes of medical care rather than on the comprehensive care of the patient over time

B.

are used to coordinate the care of members with any type of disease, either chronic or nonchronic

C.

focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition

D.

use clinical practice processes to standardize the implementation of best practices among providers

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Questions 98

Medicare Part C can be delivered by the following Medicare Advantage plans:

Options:

A.

HCCP, HMO, PPO (local or regional), PFFS or MSA.

B.

CCPs, PFFS or MSA.

C.

HMO, HSA, PPO (local or regional), PFFS or MSA.

D.

HMO, PPO (local or regional), POS, or MSA.

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Questions 99

One way that MCOs involve providers in risk sharing is by retaining a percentage of the providers' payment during a plan year. At the end of the plan year, the MCO may use the amount retained to offset or pay for any cost overruns for referral or hospital

Options:

A.

withholds

B.

usual, customary, and reasonable (UCR) fees

C.

risk pools

D.

per diems

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Questions 100

Medicaid is a jointly funded federal and state program that provides hospital and medical expense coverage to low-income individuals and certain aged and disabled individuals. One characteristic of Medicaid is that

Options:

A.

providers who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered

B.

Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all services

C.

Medicaid is always the primary payer of benefits

D.

benefits offered by Medicaid programs are federally mandated and do not vary by state

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