Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

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

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

achieves economies of scale in the group's integrated operations

all of the above

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

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

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

facilitate the processing of requests for authorization of payment of benefits

holding company of the Valentine Group

sister corporation of the Valentine Group

parent company of the Valentine Group

subsidiary of the Valentine Group

Decreased … Increased

Increased … Decreased

Increased … Increased

Decreased … Decreased

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

B only

Both A and B

Neither A nor B

A only

fixed amount in advance for each medical service the member receives

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

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

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

a physician practice organization

a physician-hospital organization

a management services organization

an integrated delivery system

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.

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

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.

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

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

must be organized on a not-for-profit basis

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

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

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

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

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

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