Free AHIP AHM-530 Exam Questions
Absolute Free AHM-530 Exam Practice for Comprehensive Preparation
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AHIP AHM-530 Exam Questions
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Provided By: AHIP
- Exam: Network Management (AHM530)
- Certification: AHIP Certification
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Total Questions: 205
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Updated On: Jan 28, 2025
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Rated: 4.9 |
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Online Users: 410
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Question 1
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One reimbursement method that health plans can use for hospitals is the ambulatory payment
classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs)
method of reimbursement. However, when comparing APCs and DRGs, one of the primary
differences between the two methods is that only the APC method
Answer: A
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One reimbursement method that health plans can use for hospitals is the ambulatory payment
classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs)
method of reimbursement. However, when comparing APCs and DRGs, one of the primary
differences between the two methods is that only the APC method
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Question 2
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The following statement(s) can correctly be made about hospitalists.1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure thatthe patient receives appropriate care while in the hospital.2. The hospitalist’s role clearly supports the health plan concept of disease management.
Answer: B
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The following statement(s) can correctly be made about hospitalists.1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure thatthe patient receives appropriate care while in the hospital.2. The hospitalist’s role clearly supports the health plan concept of disease management.
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Question 3
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Promise, Inc., a corporation that specializes in cancer services, employs its physicians and
support staff and provides facilities and ancillary services for cancer patients. Promise has
contracted with the Cordelia Health Plan to provide all specialty services for Cordelia plan
members who are undergoing cancer treatment. In return, Promise receives a capitated amount
from Cordelia. Promise is an example of a type of specialty services organization known as a
Answer: B
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Promise, Inc., a corporation that specializes in cancer services, employs its physicians and
support staff and provides facilities and ancillary services for cancer patients. Promise has
contracted with the Cordelia Health Plan to provide all specialty services for Cordelia plan
members who are undergoing cancer treatment. In return, Promise receives a capitated amount
from Cordelia. Promise is an example of a type of specialty services organization known as a
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Question 4
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The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that shecannot sue or file any claims against a Canyon plan member for covered services, even if Canyonbecomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyonwill compensate her under a typical discounted fee-for-service (DFFS) payment system.During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plandetermine how well she met Canyon's standards. The report included cumulative performancedata for Dr. Enberg and encompassed all measurable aspects of her performance. This reportincluded such information as the number of hospital admissions Dr. Enberg had and the number ofreferrals she made outside of Canyon's provider network during a specified period. Canyon alsoused process measures, structural measures, and outcomes measures to evaluate Dr. Enberg'sperformance.The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon planmember for covered services is known as:
Answer: B
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The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that shecannot sue or file any claims against a Canyon plan member for covered services, even if Canyonbecomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyonwill compensate her under a typical discounted fee-for-service (DFFS) payment system.During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plandetermine how well she met Canyon's standards. The report included cumulative performancedata for Dr. Enberg and encompassed all measurable aspects of her performance. This reportincluded such information as the number of hospital admissions Dr. Enberg had and the number ofreferrals she made outside of Canyon's provider network during a specified period. Canyon alsoused process measures, structural measures, and outcomes measures to evaluate Dr. Enberg'sperformance.The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon planmember for covered services is known as:
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Question 5
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In health plan pharmacy networks, service costs consist of two components: costs for services
associated with dispensing prescription drugs and costs for cognitive services. Cognitive services
typically include:
Answer: B
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In health plan pharmacy networks, service costs consist of two components: costs for services
associated with dispensing prescription drugs and costs for cognitive services. Cognitive services
typically include: