Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Retrospective experience rating

Adjusted community rating

Community rating by class

Community rating

GPWW combines multiple independent physician practices under one umbrella organization

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

member physicians cannot own the GPWW

GPWW's member physicians must perform their own business operations

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

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

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

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

exempted HMOs from all state licensure requirements.

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

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

established a process by which HMOs could obtain federal qualification

$0

$300

$400

$900

Has ever participated in any quality improvement activities.

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

Meets the requirements of the Ethics in Patient Referrals Act.

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

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

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

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

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

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

CCPs, PFFS or MSA.

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

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

withholds

usual, customary, and reasonable (UCR) fees

risk pools

per diems

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

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

Medicaid is always the primary payer of benefits

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