AHM-250 Exam Dumps - AHIP Certification Questions and Answers

Health savings accounts (HSAs)

Health reimbursement arrangements (HRAs)

Medical savings accounts (MSAs)

Flexible spending arrangements (FSAs)

Electronic transmittal of authorization is subject to the same regulatory requirements as other methods of transmittal

Telephone transmittal increases data entry errors.

Medical review is conducted before administrative review.

Prospective review, concurrent review and retrospective review are types of utilization review

emphasized compensating physicians based solely on the volume of medical services they provide

exempted HMOs from all state licensure requirements

established a process under which HMOs could elect to be federally qualified

required federally qualified HMOs to relate premium levels to the health status of the individual enrollee or employer group

Unlike a consolidated medical group, physicians in a 'Clinic without walls' maintain their practices independently in multiple locations.

Unlike a consolidated medical group, a 'Clinic without walls' performs or arranges for business operations for the member physicians.

Both A & B

True

False

a manual rating contract

a funding vehicle contract

an administrative services only (ASO) contract

a pooling contract

Furnished in the least intensive type of medical care setting required by the member's condition.

Solely for the convenience of the member.

In accordance with the standards of good medical practice.

Consistent with the symptoms of the member's condition.

The license that HMOs get in each state is called ‘Certificate of Authority’

The HMO contracts directly with the individual physicians who provide the medical services to the HMO members in a variation of the IPA model called direct contract model HMO.

All medicare/mediclaim beneficiaries should comply with utilization management requirements set forth by HCFA

HMO’s usually impose high coinsurance or deductible requirements

quality assurance provision

performance-based financial provision

dual-choice provision

stop-loss provision

MSAs were established as a demonstration project under the Medicare Modernization Act.

MSAs were seen as an improvement over FSAs because they are portable, allowing employees to take the funds with them when they change jobs.

The popularity of MSAs has been limited because funds may not be rolled over from year to year.

MSAs are one of the fastest growing Types of Consumer-Directed Health Plans.