AHM-250無料問題集「AHIP Healthcare Management: An Introduction」

質問 1

The Citywide Health Group is a large provider-based health plan that includes physician groups, hospitals, and other facilities. In order to oversee and manage the operation of the organization, Citywide has established an enterprise scheduling system. The

（A）detect instances of overutilization, underutilization, or inappropriate utilization of medical resources

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

（C）facilitate the processing of requests for authorization of payment of benefits

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

正解：B 解答を投票する

質問 2

The Panacea Healthcare System is a single large medical practice based in Oakland, California. The physicians of Panacea operate through a single office located in the Beverly Hills region of Oakland & do have access to the same medical records. Panacea is owned by Queen's hospital & before Panacea acquired the practices of its participating physicians, these physicians were independent practitioners. Which of the following terms best describes Panacea?

（A）Physician Hospital Organization

（B）None of the above

（C）Physician Practice Management Compare

（D）Consolidated Medical Group

正解：D 解答を投票する

質問 3

Consumer-directed health plans are not a new concept. They actually got their start in the late 1970s with the advent of:

（A）Health savings accounts (HSAs)

（B）Medical savings accounts (MSAs)

（C）Flexible spending arrangements (FSAs)

（D）Health reimbursement arrangements (HRAs)

正解：C 解答を投票する

質問 4

Arrange the following provider organizations in the order ranging from least integrated.
I. Physician Practice Management (PPM) company
II. Integrated Delivery System (IDS)
III. Group Practice Without Walls (GPWW)
IV.
Independent Practice Association (IPA)

（A）I, II, III, IV

（B）I, IV, II, III

（C）IV, III, I, II

（D）I, II, IV, III

正解：C 解答を投票する

質問 5

Health plans often carve out specialty services that have one or more of the following characteristics

（A）High or increasing costs

（B）Appropriate utilization

（C）A poorly defined patient population

（D）All the above

正解：A 解答を投票する

質問 6

Which of the following is NOT a factor that is used by MCOs to determine which services will undergo utilization review?

（A）Access requirements

（B）Concurrent review

（C）Cost of review

（D）Cost per procedure

正解：A 解答を投票する

質問 7

Utilization data can be transmitted to the health plan manually, by telephone, or electronically. Compared to other methods of data transmittal, manual transmittal is generally

（A）more acceptable to physicians

（B）less cumbersome and labor intensive

（C）subject to greater scrutiny by regulatory bodies

（D）faster and more accurate

正解：A 解答を投票する

質問 8

If most of the physicians, or many of the physicians in a particular specialty, are affiliated with a single entity, then a health plan building a network in the service area _____________.

（A）Should not contract with that entity

（B）Has many contracting options available.

（C）Most likely needs to contract with that entity

（D）Should attempt to disband the existing affiliations

正解：C 解答を投票する

質問 9

PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, t

（A）capitation contract

（B）fee-for-service arrangement

（C）risk sharing contract

（D）rebate contract

正解：C 解答を投票する

質問 10

Which of the following features differentiates a 'Clinic without walls1 from a consolidated medical group?

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

（B）Both A & B

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

正解：A 解答を投票する

質問 11

The Koster Company plans to purchase a health plan for its employees from Intuitive HMO. Intuitive will administer the plan and will bear the responsibility of guaranteeing claim payments by paying all incurred covered benefits. Koster will pay for the he

（A）fully funded plan

（B）self-pay plan

（C）stop-loss plan

（D）self-funded plan

正解：A 解答を投票する

質問 12

According to the IRS, which of the following is not an allowable preventive care service?

（A）Immunizations for children and adults.

（B）Smoking cessation programs.

（C）Health club memberships.

（D）Periodic health examinations.

正解：C 解答を投票する

質問 13

In the CPT system, each service or procedure is identified by

（A）Five-digit with decimal point

（B）Three-digit

（C）Five-digit

（D）Three-digit with decimal point

正解：C 解答を投票する

質問 14

One distinguishing characteristic of a health maintenance organization (HMO) is that, typically, an HMO

（A）must be organized on a not-for-profit basis

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

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

（D）must be federally qualified in order to conduct business in any state

正解：B 解答を投票する

質問 15

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 practice management (PPM) Casa- physician hospital organization (PHO) company.

（B）Iota- physician hospital organization (PHO)Casa- medical foundation.

（C）Iota- medical foundation Casa- management services organization (MSO).

（D）Iota- physician hospital organization (PHO)Casa- physician practice management (PPM) company.

正解：A 解答を投票する

質問 16

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 professionals in academia and businesspeople who do not work for Polestar. Dr. Carolyn Porter, a university president, is on Polestar's board. From the following answer choices, select the response containing the term that correctly identifies Polestar's relationship to Polaris and the term that describes the type of board member represented by Dr. Porter

（A）Poles tar's relationship to Polaris: holding company: Type of board member: outside director

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

（C）Polestar's relationship to Polaris: partnership: Type of board member: operations director

（D）Polestar's relationship to Polaris: holding company: Type of board member: operations director

正解：A 解答を投票する

AHM-250 無料問題集「AHIP Healthcare Management: An Introduction」

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