AHM-250 Online Practice Questions and Answers

A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

A. the specialists in the PHO are typically compensated on a capitation basis

B. the specialists in the PHO are typically compensated on a capitation basis

C. it typically limits the number of specialists by type of specialty

D. it is available to a hospital's entire eligible medical staff

E. physician membership in the PHO is limited to PCPs

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 Dr. Aldridge's provider contract with Badger will automatically terminate if he loses his medical license or hospital privileges.

B. 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.

C. Give Dr. Aldridge the right to appeal Badger's decision if he is terminated with cause from Badger's provider network.

D. Specify that Badger can terminate this provider contract without providing a reason, but only if Badger gives Dr. Aldridge at least 90-days' notice of its intent to terminate the contract.

From the following answer choices, choose the description of the ethical principle that best corresponds to the term Autonomy

A. Health plans and their providers are obligated not to harm their members

B. Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

C. Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members

D. Health plans and their providers have a duty to respect the right of their members to make decisions about the course of their lives

The situation wherein two hospitals agree to each refuse to contract with a health plan until the health plan cease contract negotiations with a competing hospital is known as

A. Horizontal division of markets

B. Tying arrangements

C. Horizontal group boycott

D. Price fixing

The statements below describe technology used by two MCOs to respond to incoming telephone calls:

The Morton MCO uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond to a menu of option

A. Autumn's device is best described as an interactive voice response (IVR) system.

B. Both Morton's system and Autumn's device are applications of computer/telephony integration (CTI).

C. Morton's system is best described as an automatic call distributor (ACD).

D. Morton's system can be correctly characterized as an expert system.

The Helm MCO segmented the non-group market for its new healthcare product by using factors such as education level, gender, and household composition. The Amberly MCO segmented the non-group market for its products based on the approaches by which it solution

A. demographic product or benefit

B. geographic distribution channel

C. demographic distribution channel

D. geographic product or benefit

The health plan determines what it considers to be the acceptable fee for a service or procedure and the physician agrees to accept that amount as payment in full for the procedure

A. Usual, Customary, and Reasonable fee

B. Discounted FFS

C. Fee Maximum

D. Relative Value Scale

The Meadowcreek Group is an organization comprised of individual physicians and physicians in small group practices. Meadowcreek enters into contracts with health plans, and then Meadowcreek contracts separately with its physician members. In situations with

A. a group practice without walls (GPWW)

B. a messenger model

C. an individual practice association (IPA)

D. a Physician Practice Management (PPM) company

The Neptune Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot afford to pay for the care by themselves or who receive services at reduced rates because they are covered under govern me

A. cost shifting

B. Anti selection

C. receivership

D. Underwriting

To address the problems associated with multiple data management systems, the Kayak Health Plan has begun to use a data warehouse. One likely characteristic of Kayak's data warehouse is that:

A. It requires Kayak's individual databases to store large amounts of data that are not needed for daily operations.

B. It contains data from internal sources only.

C. It stores historical data rather than current data.

D. The data in the warehouse are linked by a common subject.