Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

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

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.

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

HMO’s usually impose high coinsurance or deductible requirements

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

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

Both A & B

Percentage of adult plan members who receive regular medical checkups.

Number of plan members contracting an infection in the hospital.

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

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

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

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.

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

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

Three-digit with decimal point

Three-digit

Five-digit with decimal point

Five-digit

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

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

Both A & B

None of the above

UCR fee

Capitation fee

Balance bill

Discounted fee-for-service

Usual, Customary, and Reasonable fee

Discounted FFS

Fee Maximum

Relative Value Scale

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.

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

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

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

I, II, III, IV

IV, III, I, II

I, II, IV, III

I, IV, II, III