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Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Questions 1

One type of physician-only integration model is a consolidated medical group. Typical characteristics of a consolidated medical group include

Options:

A.

that it may be a single-specialty or multi-specialty practice

B.

operates in one or a few facilities rather than in many independent offices

C.

achieves economies of scale in the group's integrated operations

D.

all of the above

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Questions 2

The Citywide Health Group is a large provider-based health plan that includes physician groups, hospitals, and other facilities. In order to oversee and manage the operation of the organization, Citywide has established an enterprise scheduling system. The

Options:

A.

provide information to Citywide's management regarding provider licensure, certification, and malpractice history

B.

detect instances of overutilization, underutilization, or inappropriate utilization of medical resources

C.

allow Citywide's different components to function as a single organization in arranging access to facilities and resources

D.

facilitate the processing of requests for authorization of payment of benefits

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Questions 3

The Clover Group is a for-profit MCO that operates in the United States. The Valentine Group owns all of Clover's stock. The Valentine Group's sole business is the ownership of controlling interests in the shares of other companies. This information indic

Options:

A.

holding company of the Valentine Group

B.

sister corporation of the Valentine Group

C.

parent company of the Valentine Group

D.

subsidiary of the Valentine Group

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Questions 4

The following sentence contains an incomplete statement with two missing words. Select the answer choice that contains the words that correctly fill the two blanks, respectively. The philosophy of consumer choice involves having consumers play a(n) ______

Options:

A.

Decreased … Increased

B.

Increased … Decreased

C.

Increased … Increased

D.

Decreased … Decreased

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Questions 5

Some providers use electronic medical records (EMRs) to document their patients' care in an electronic form. The following statement(s) can correctly be made about EMRs:

Options:

A.

EMRs are computerized records of a patient's clinical, demographic, and administrator

B.

B only

C.

Both A and B

D.

Neither A nor B

E.

A only

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Questions 6

Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

Options:

A.

fixed amount in advance for each medical service the member receives

B.

a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider

C.

a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services

D.

specified amount of the member's medical expenses before any benefits are paid by the HMO

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Questions 7

John Kerry's employer has contracted to receive healthcare for its employees from the Democratic Healthcare System. Mr. Kerry visits his PCP, who sends him to have some blood tests. The PCP then refers Mr. Kerry to a specialist who hospitalizes him for on

Options:

A.

a physician practice organization

B.

a physician-hospital organization

C.

a management services organization

D.

an integrated delivery system

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Questions 8

Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

Options:

A.

Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.

B.

Health plans are never allowed to medically underwrite individual market customers who are under age 65.

C.

To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.

D.

Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.

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Questions 9

One distinguishing characteristic of a health maintenance organization (HMO) is that, typically, an HMO

Options:

A.

arranges for the delivery of medical care and provides, or shares in providing, the financing of that care

B.

must be organized on a not-for-profit basis

C.

may be organized as a corporation, a partnership, or any other legal entity

D.

must be federally qualified in order to conduct business in any state

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Questions 10

Several marketplace factors helped fuel the movement toward consumer choice. Which one of the following statements is NOT accurate with regard to these factors?

Options:

A.

After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.

B.

During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.

C.

Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.

D.

Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.

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