Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Acquisition of the Leopard Health Plan by the Hickory Health Plan.

Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

Consolidation of the Carver Health Plan and the Limestone Health Plan.

ambulance and the diagnostic tests

ambulance, the diagnostic tests, and the physician's professional services

cost of hospitalization

cost of hospitalization and the physician's professional services

limits coverage to eligible employees and excludes part-time employees

specifies an annual lifetime benefit maximum on dollar coverage for medical costs

provides benefits regardless of the cause of an injury or illness

provides benefits for both healthcare costs and lost wages

provider profiling

benchmarking

peer review

quality assessment

provide less extensive benefits than those provided under traditional indemnity plans

place a greater emphasis on preventive care than do traditional indemnity plans

require members to pay a percentage of the cost of medical services rendered after a claim is filed, rather than a fixed copayment at the time of service as required by indemnity plans

contain cost-sharing requirements that result in more out-of-pocket spending by members than do the cost-sharing requirements in traditional indemnity plans

treat each member in a manner that respects his or her own goals and values

allocate resources in a way that fairly distributes benefits and burdens among the members

present information honestly to their members and to honor commitments to their members

make sure they do not harm their members

Credentialing

Accreditation

A sentinel event

A screening program

a defined patient population

a complex benefit structure

low, stable costs

appropriate utilization rates

Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.

Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because Mr. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.

Can exclude coverage for treatment of Mr. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.

Cannot exclude his angina as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under his previous health plan.

MBHOs generally provide benefits for mental health services but not for chemical dependency services.

The level of care needed to treat behavioral disorders is the same for all patients and all disorders.

By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.

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.