AHIP AHIP Certification AHM-250 Questions & Answers

• Question 11:

  The following statements describe common types of physician/hospital integrated models:

  (A)

  The Alpha 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

  A.

  Physician hospital organization physician practice management company

  B.

  Physician practice management company physician hospital organization

  C.

  Medical foundation management services company

  D.

  Physician hospital organization medical foundation

  Correct Answer: B

• Question 12:

  Which of the following is(are) CORRECT?

  (A)

  Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.

  (B)

  Staff model HMOs are closed panel.

  (C)

  Staff model HMOs operate out of ambulatory care facilities.

  A.

  A and B

  B.

  None of the listed options

  C.

  B and C

  D.

  All of the listed options

  Correct Answer: D

• Question 13:

  Utilization review offers health plans a means of managing costs by managing

  A. Cost effectiveness of healthcare services.

  B. Cost of paying healthcare benefits.

  C. Both of the above

  Correct Answer: C

• Question 14:

  Which facility would best meet the need of Jack who fell on road and sprained his ankle?

  A. Emergency Department

  B. Urgent Care Centre

  C. Home health care

  D. None of the above

  Correct Answer: B

• Question 15:

  Which of the following factors have contributed to the limited popularity of FSAs

  A. "Use it or lose it" provision

  B. Lack of portability

  C. Only self-employed individuals are eligible for establishing FSAs.

  D. Both A andB

  Correct Answer: D

• Question 16:

  The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

  A. An indemnity wraparound plan

  B. A self-funded plan

  C. An aggregate stop-loss plan

  D. A fully funded plan

  Correct Answer: D

• Question 17:

  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.

  Correct Answer: C

• Question 18:

  Types of alternative care centers include urgent care centers, observation care units, and stepdown units. One difference between the costs associated with alternative care centers is that, compared to the cost of:

  A. Facilities, equipment, and staffing in hospital emergency departments (EDs), the cost of facilities, equipment, and staffing in observation care units is generally lower

  B. Care delivered in urgent care centers, the cost of care delivered in hospital emergency departments (EDs) is generally lower.

  C. Care in step-down units, the cost of acute inpatient care is generally lower.

  D. Primary care in a physician's office, the cost of care delivered in urgent care centers is generally lower.

  Correct Answer: A

• Question 19:

  The Polestar Company's sole business is the ownership of Polaris Medical Group, a health plan and subsidiary of Polestar. Some members of Polestar's board of directors hold positions with Polestar in addition to their positions on the board; the rest are

  A. Polestar's relationship to Polaris: partnership Type of board member: operations director

  B. Polestar's relationship to Polaris: partnership Type of board member: outside director

  C. Polestar's relationship to Polaris: holding company Type of board member: operations director

  D. Polestar's relationship to Polaris: holding company Type of board member: outside director

  Correct Answer: D

• Question 20:

  Which of the following statements is true?

  A. A declining economy can lead to lower healthcare costs as a result of an older population with greater healthcare needs.

  B. A larger patient population increases pressure on the health plan to offer larger panels.

  C. Provider networks are not affected by the federal and state laws that apply to health plans

  D. Network management standards established by independent accrediting organizations have no influence on health plan network design.

  Correct Answer: B