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AHM-250 Product Description:
Exam Number/Code: AHM-250 vce
Exam name: Healthcare Management: An Introduction
n questions with full explanations
Certification: AHIP Certification
Last updated on Global synchronizing

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

  • A. Physician Practice Management (PPM) companyI
  • B. Integrated Delivery System (IDS)II
  • C. Group Practice Without Walls (GPWW)I
  • D. Independent Practice Association (IPA)
  • E. I, II, III, IV
  • F. IV, III, I, II
  • G. I, II, IV, III
  • H. I, IV, II, III

Answer: B


The statements below describe technology used by two health plans to respond to incoming telephone calls:
✑ The Manor Health Plan uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond t

  • A. Manor's system is best described as an automated call distributor (ACD).
  • B. Both Manor's system and Squire's device are applications of computer/telephone integration (CTI).
  • C. Squire's device is best described as an interactive voice response (IVR) system.
  • D. All of these statements are correct.

Answer: B


The Mirror Health Plan uses a form of computer/telephony integration (CTI) to manage telephone calls coming into its member services department. When a member calls the plan's central telephone number, a device answers the call with a recorded message and

  • A. a member outreach program
  • B. a complaint resolution procedure (CRP)
  • C. an automatic call distributor (ACD)
  • D. an interactive voice response (IVR) system

Answer: C


In health plan terminology, demand management, as used by health plans, can best be described as

  • A. an evaluation of the medical necessity, efficiency, and/or appropriateness of healthcare services and treatment plans for a given patient
  • B. a series of strategies designed to reduce plan members' needs to utilize healthcare services by encouraging preventive care, wellness, member self-care, and appropriate use of healthcare services
  • C. a technique that prevents a provider who is being reimbursed under a fee schedule arrangement from billing a plan member for any fees that exceed the maximum fee reimbursed by the plan
  • D. a system of identifying plan members with special healthcare needs, developing a healthcare strategy to meet those needs, and coordinating and monitoring the care

Answer: B


Integration of provider organizations is said to occur when

  • 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

Answer: C


An HMO’s quality assurance program must include

  • A. A statement of the HMO’s goals and objectives for evaluating and improving enrollees’ health status
  • B. Documentation of all quality assurance activities
  • C. System for periodically reporting program results to the HMO’s board of directors, its providers, and regulators
  • D. All the above

Answer: D


The following statements describe common types of physician/hospital integrated models:
The Iota Company, which is owned by a group of investors, is a for-profit legal entity that buys entire physician practices, not just the tangible assets of the practice

  • A. Iota- physician hospital organization (PHO)Casa- physician practice management (PPM) company.
  • B. Iota- physician hospital organization (PHO)Casa- medical foundation.
  • C. Iota- physician practice management (PPM) Casa- physician hospital organization (PHO) company.
  • D. Iota- medical foundation Casa- management services organization (MSO).

Answer: C


The Courtland PPO maintains computerized records that include clinical, demographic, and administrative data about individual plan members. The data in these records is available to plan providers, ancillary service departments, pharmacies, and others inv

  • A. a data warehouse
  • B. a decision support system
  • C. an outsourcing system
  • D. an electronic medical record (EMR) system

Answer: D


The following statements describe corporate transactions: Transaction A – An MCO acquired another MCO.
Transaction B – A group of providers formed an organization to carry out billings, collections, and contracting with MCOs for the entire group of provide

  • A. A and C only
  • B. A, B, and C
  • C. B and C only
  • D. A and B only

Answer: A


The HMO Act of 1973 was significant in that the Act

  • A. mandated certain requirements that all HMOs had to meet in order to conduct business
  • B. required that all HMOs be licensed as insurance companies
  • C. offered HMOs federal financial assistance through grants and loans, and provided access to the employer-based insurance market
  • D. encouraged the use of pre-existing condition exclusion provisions in all HMO contracts

Answer: C


One true statement regarding ethics and laws is that the values of a community are reflected in

  • A. both ethics and laws, and both ethics and laws are enforceable in the court system
  • B. both ethics and laws, but only laws are enforceable in the court system
  • C. ethics only, but only laws are enforceable in the court system
  • D. laws only, but both ethics and laws are enforceable in the court system

Answer: B


Dr. Samuel Aldridge's provider contract with the Badger Health Plan includes a typical due process clause. The primary purpose of this clause is to:

  • A. State that D
  • B. Aldridge's provider contract with Badger will automatically terminate if he loses his medical license or hospital privileges.
  • C. Specify a time period during which the party that breaches the provider contract must remedy the problem in order to avoid termination of the contract.
  • D. Give D
  • E. Aldridge the right to appeal Badger's decision if he is terminated with cause from Badger's provider network.
  • F. Specify that Badger can terminate this provider contract without providing a reason, but only if Badger gives D
  • G. Aldridge at least 90-days' notice of its intent to terminate the contract.

Answer: C


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

  • A. a physician practice organization
  • B. a physician-hospital organization
  • C. a management services organization
  • D. an integrated delivery system

Answer: D


Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

  • A. an integrated delivery system (IDS)
  • B. a Management Services Organization (MSO)
  • C. a Physician Practice Management (PPM) company
  • D. a physician-hospital organization (PHO)

Answer: A


Specialty services that have certain characteristics generally are good candidates for managed care approaches. These characteristics generally include that the specialty service should have

  • A. appropriate, rather than inappropriate, utilization
  • B. a defined patient population
  • C. low, stable costs
  • D. a benefit that cannot be easily defined

Answer: B


In order to compensate for lost revenue resulting from services provided free or at a significantly reduced cost to other patients, many healthcare providers spread these unreimbursed costs to paying patients or third-party payors. This practice is known

  • A. dual choice
  • B. cost shifting
  • C. accreditation
  • D. defensive medicine

Answer: B


The following statements are about the non-group market for managed care products in the United States. Select the answer choice containing the correct statement.

  • A. In order to promote a product to the individual market, MCOs typically rely on personal selling by captive agents rather than on promotional tools such as direct mail, telemarketing, and advertising.
  • B. Managed Medicare plans typically are allowed to reject a Medicare applicant on the basis of the results of medical underwriting of the applicant.
  • C. HCFA (now known as the Centers for Medicare and Medicaid Services) must approve all membership and enrollment materials used by MCOs to market managed care products to the Medicare population.
  • D. Managed care plans are not allowed to health screen individual market customers who are under age 65, even if the health screen could help prevent anti selection.

Answer: C


Who will be covered by TRICARE PRIME by applying for enrollment

  • A. Active duty military personnel
  • B. Active duty Dependents
  • C. Retires
  • D. B and C

Answer: D


The following statements are about health information networks (HINs). Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement.

  • A. Most HINs are built on proprietary computer networks rather than being Internet based.
  • B. While a HIN is for the exclusive use of one organization, a community health information network (CHIN) is shared by several organizations.
  • C. A health plan can use a secured extranet design or a distributed database approach for its HIN.
  • D. HINs have the potential to increase the quality of medical care because they make a patient's medical history readily available to each provider at the point of service.

Answer: A


A differences between managed indemnity & traditional indemnity

  • A. Include precertification and utilization review techniques
  • B. Both are the same
  • C. Include network and quality review techniques
  • D. A & B

Answer: C


The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. In early efforts to manage healthcare costs, traditional indemnity health insurers included in their health pla

  • A. cost shifting
  • B. deductibles
  • C. underwriting
  • D. copy

Answer: B


The following programs are typically included in TRICARE medical management efforts:

  • A. Utilization management
  • B. Self-care
  • C. Case management
  • D. A and B only
  • E. A and C only
  • F. All of the listed options
  • G. B and C only

Answer: C


The following statement(s) can correctly be made about Medicaid managed care plans:

  • A. A state may mandate health plan enrollment if it offers enrollees in non-rural areas a choice of at least two health plans and offers rural enrollees a choice of at lea
  • B. Both A and B
  • C. A only
  • D. B only
  • E. Neither A nor B

Answer: A


Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr. Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

  • A. a traditional HMO plan
  • B. a managed indemnity plan
  • C. a point of service (POS) option
  • D. an exclusive provider organization (EPO)

Answer: C


In order to measure the expenses of institutional utilization, Holt Health care group uses standard formula to calculate hospital bed stays per 1000 plan members. On 26 November, Holt uses the following information to:
Calculate the bed days per 1000 members for the MTD Total gross hospital bed days in MTD = 500
Plan membership = 15000
Calculate Holt's number of bed days per 1000 members for the month to date, rounded to the nearest whole number.

  • A. 468
  • B. 365
  • C. 920
  • D. 500

Answer: A


Paul Gilbert has been covered by a group health plan for two years. He has been undergoing treatment for angina for the past three months. Last week, Mr. Gilbert began a new job and immediately enrolled in his new company's group health plan, which has a

  • A. Can exclude coverage for treatment of M
  • B. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.
  • C. Can exclude coverage for treatment of M
  • D. Gilbert's angina for one year, because M
  • E. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.
  • F. Can exclude coverage for treatment of M
  • G. 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.
  • H. 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.

Answer: D


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