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Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Questions 31

Which of the following statements is FALSE?

Options:

A.

The license that HMOs get in each state is called ‘Certificate of Authority’

B.

The HMO contracts directly with the individual physicians who provide the medical services to the HMO members in a variation of the IPA model called direct contract model HMO.

C.

All medicare/mediclaim beneficiaries should comply with utilization management requirements set forth by HCFA

D.

HMO’s usually impose high coinsurance or deductible requirements

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Questions 32

Which of the following features differentiates a 'Clinic without walls1 from a consolidated medical group?

Options:

A.

Unlike a consolidated medical group, physicians in a 'Clinic without walls' maintain their practices independently in multiple locations.

B.

Unlike a consolidated medical group, a 'Clinic without walls' performs or arranges for business operations for the member physicians.

C.

Both A & B

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Questions 33

The measures used to evaluate healthcare quality are generally divided into three categories: process, structure, and outcomes. An example of a process measure that can be used to evaluate a health plan's performance is the:

Options:

A.

Percentage of adult plan members who receive regular medical checkups.

B.

Number of plan members contracting an infection in the hospital.

C.

Percentage of board certified physicians within the health plan's network.

D.

Number of hospital admissions for plan members with certain medical conditions.

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Questions 34

The following statements are about preferred provider organizations (PPOs). Select the answer choice that contains the correct statement.

Options:

A.

PPOs generally assume full financial risk for arranging medical services for their members.

B.

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.

C.

PPO networks may include primary care physicians and hospitals, but generally do not include specialists.

D.

In a PPO, the most common method used to reimburse physicians is capitation.

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Questions 35

In the CPT system, each service or procedure is identified by

Options:

A.

Three-digit with decimal point

B.

Three-digit

C.

Five-digit with decimal point

D.

Five-digit

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Questions 36

Integration of provider organizations is said to occur when

Options:

A.

Previously separate providers combine & come under common ownership or control.

B.

Two or more providers combine their business operations that they previously carried out separately.

C.

Both A & B

D.

None of the above

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Questions 37

Bill the member for the balance of the fee above the maximum allowable amount under the fee schedule reimbursement method

Options:

A.

UCR fee

B.

Capitation fee

C.

Balance bill

D.

Discounted fee-for-service

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Questions 38

The health plan determines what it considers to be the acceptable fee for a service or procedure and the physician agrees to accept that amount as payment in full for the procedure

Options:

A.

Usual, Customary, and Reasonable fee

B.

Discounted FFS

C.

Fee Maximum

D.

Relative Value Scale

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Questions 39

The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Three of these statements are true and one statement is false. Select the answer choice

Options:

A.

Factors that have increased the demand for behavioral healthcare services include increased stress on individuals and families and the increasing availability of behavioral healthcare services.

B.

To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) use only two basic strategies: alternative treatment levels and crisis intervention.

C.

The treatment approaches for behavioral healthcare most often include drug therapy, psychotherapy, and counseling.

D.

The development of alternative treatment options, incorporation of community-based resources into the healthcare system, and increased reliance on case management have shifted the emphasis of managed behavioral healthcare from meeting the service needs of

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Questions 40

Arrange the following provider organizations in the order ranging from least integrated.

I. Physician Practice Management (PPM) company

II. Integrated Delivery System (IDS)

III. Group Practice Without Walls (GPWW)

IV. Independent Practice Association (IPA)

Options:

A.

I, II, III, IV

B.

IV, III, I, II

C.

I, II, IV, III

D.

I, IV, II, III

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