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Guide for AHM-250: AHIP Healthcare Management: An Introduction

Quiz AHM-250: AHIP Healthcare Management: An Introduction

Updated on 2026/09/08

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Guide for AHM-250: AHIP Healthcare Management: An Introduction

Updated on 2026/09/08

Randomized | 10 Questions per Test | 20 Minutes | 70% to pass

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Question: / 10

4.8

Quiz

Question 1/101/10

The following statements describe two types, or models, of HMOs:
The Quest HMO has contracted with only one multi-specialty group of physicians. These physicians
are employees of the group practice, have an equity interest in the practice, and provide

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1 correct answer

A captive group a staff model

A captive group a network model

An independent group a network model

An independent group a staff model

The correct answer is B. A captive group a network model.
Here’s why:
An HMO can be organized in different ways depending on how it contracts with physicians.
1. Staff model HMO
In a staff model, the HMO employs the physicians directly. The doctors work for the HMO itself, not for an outside medical group.
2. Group model HMO
In a group model, the HMO contracts with one physician group rather than employing the doctors directly. The physicians work for that group practice, not as employees of the HMO.
3. Captive group
A captive group means the HMO contracts with only one medical group. That is exactly what the question describes: Quest HMO has contracted with only one multi-specialty group of physicians.
4. Network model
In a network model, the HMO contracts with more than one group or medical entity. Even though the word “network” sometimes suggests multiple providers, in this question the correct choice is tied to the fact that the physicians belong to a contracted group rather than being HMO employees.
Why B is correct
The question says:
- Quest HMO has contracted with only one multi-specialty group of physicians
- The physicians are employees of the group practice
- They have an equity interest in the practice
This means the physicians are not employees of the HMO, so it is not a staff model. Instead, they belong to a contracted group practice, which makes it a captive group arrangement. Among the answer choices, B is the one that matches that structure.
Why the other options are incorrect
A. A captive group a staff model
Incorrect because a staff model means the physicians are employed by the HMO, not by an outside group practice.
C. An independent group a network model
Incorrect because the question says Quest HMO has contracted with only one group, not multiple independent groups.
D. An independent group a staff model
Incorrect because staff model physicians are HMO employees, and the scenario clearly describes physicians employed by the group practice instead.
Summary
The key clue is that the HMO contracted with one physician group, and the doctors are employees of that group practice. That is a captive group arrangement, not a staff model. Therefore, the best answer is B.

Right Answer: B

Quiz

Question 2/102/10

HMOs can't medically underwrite any group – incl small groups.

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1 correct answer

State

Not-for-profit

For-profit

Federally qualified

Quiz

Question 3/103/10

A common physician-only integrated model is a group practice without walls (GPWW). One
characteristic of a typical GPWW is that the

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1 correct answer

GPWW combines multiple independent physician practices under one umbrella organization

GPWW generally has a lesser degree of integration than does an IPA

member physicians cannot own the GPWW

GPWW's member physicians must perform their own business operations

Quiz

Question 4/104/10

A health plan may use one of several types of community rating methods to set premiums for a
health plan. The following statements are about community rating. Select the answer choice
containing the correct statement.

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1 correct answer

Standard (pure) community rating is typically used for large groups because it is the most competitive rating method for large groups.

Under standard (pure) community rating, a health plan charges all employers or other group sponsors the same dollar amount for a given level of medical benefits or health plan, without adjusting for factors such as age, gender, or experience.

In using the adjusted community rating (ACR) method, a health plan must consider the actual experience of a group in developing premium rates for that group.

The Centers for Medicare and Medicaid Services (CMS) prohibits health plans that assume Medicare risk from using the adjusted community rating (ACR) me

Quiz

Question 5/105/10

A health plan's ability to establish an effective provider network depends on the characteristics of the
proposed service area and the needs of proposed plan members. It is generally correct to say that

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1 correct answer

health plans have more contracting options if providers are affiliated with single entities than if providers are affiliated with multiple entities

urban areas offer more flexibility in provider contracting than do rural areas

consumers and purchasers in markets with little health plan activity are likely to be more receptive to HMOs than to loosely managed plans such as PPOs

large employers tend to adopt health plans more slowly than do small companies

Quiz

Question 6/106/10

A health savings account must be coupled with an HDHP that meets federal requirements for
minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for
inflation. For 2006, the annual deductible for self-only coverage must

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1 correct answer

$525

$1,050

$2,100

$5,250

Quiz

Question 7/107/10

A medical foundation is a not-for-profit entity that purchases and manages physician practices. In
order to retain its not-for-profit status, a medical foundation must

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1 correct answer

Provide significant benefit to the community

Employ, rather than contract with, participating physicians

Achieve economies of scale through facility consolidation and practice management

Refrain from the corporate practice of medicine

Quiz

Question 8/108/10

A particular health plan offers a higher level of benefits for services provided in-network than for
out-of-network services. This health plan requires preauthorization for certain medical services.
With regard to the steps that the health plan's claims e

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1 correct answer

should assume that all services requiring preauthorization have been preauthorized

should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim

need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits

need not determine whether the member is covered by another health plan that allows for coordination of benefits

Quiz

Question 9/109/10

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

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1 correct answer

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

it typically limits the number of specialists by type of specialty

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

physician membership in the PHO is limited to PCPs

Quiz

Question 10/1010/10

A public employer, such as a municipality or county government would be considered which of the
following?

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1 correct answer

Employer-employee group

Multiple-employer group

Affinity group

Debtor-creditor group

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Quiz name:AHM-250: AHIP Healthcare Management: An Introduction
Total number of questions:367
Number of questions for the test:50
Pass score:80%

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