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AHM-530Exam Code: AHM-530
Exam Name: Network Management
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AHM-530 Latest Dumps Total Q&A: 202 Questions and Answers
Last Update: 2015-07-27

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NO.1 In 1996, the NAIC adopted a standard for health plan coverage of emergency services. This
standard is based on a concept known as the:
A. Due process standard
B. Subrogation standard
C. Corrective action standard
D. Prudent layperson standard
Answer: D

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NO.2 Dr. Sarah Carmichael is one of several network providers who serve on one of the Apex Health
Plan's organizational committees. The committee reviews cases against providers identified through
complaints and grievances or through clinical monitoring activities. If needed, the committee
formulates, approves, and monitors corrective action plans for providers. Although Apex
administrators and other employees also serve on the committee, only participating providers have
voting rights. The committee that Dr. Carmichael serves on is a
A. Utilization management committee
B. Peer review committee
C. Medical advisory committee
D. Credentialing committee
Answer: B

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NO.3 The Bruin Health Plan is a Social Health Maintenance Organization (SHMO). As an SHMO, Bruin:
A. Must provide Medicare participants with standard HMO benefits, as well as with limited long-term
care benefits
B. Does not need as great a variety of provider types or as complex a reimbursement method as does
a traditional HMO
C. Receives a payment that is based on reasonable costs and reasonable charges
D. Most likely provides fewer supportive services than does a traditional HMO, because one of Bruin's
goals is to minimize the use of community-based care
Answer: A

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NO.4 In open panel contracting, there are several types of delivery systems. One such delivery system
is the faculty practice plan (FPP). One likely result that a health plan will experience by contracting
with an FPP is that the health plan will
A. be able to select most of the physicians in the FPP
B. achieve the highest level of cost effectiveness possible
C. experience limited control over utilization
D. achieve the most effective case management possible
Answer: C

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NO.5 The Ionic Group, a provider group with 10,000 plan members, purchased for its hospital risk
pool aggregate stop-loss insurance with a threshold of 110% of projected costs and a 10%
coinsurance provision. Ionic funds the hospital risk pool at $40 per member per month (PMPM).
If Ionic's actual hospital costs are $5,580,000 for the year, then, under the aggregate stop-loss
agreement, the stop-loss insurer is responsible for reimbursing Ionic in the amount of
A. $30,000
B. $270,000
C. $300,000
D. $702,000
Answer: B

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NO.6 One true statement about the compensation arrangement known as the case rate system is
that, under this system,
A. Providers stand to gain or lose based on the number and types of treatments used for each case
B. Providers have no incentives to take an active role in managing cost and utilization
C. Payors cannot adjust standard case rates to reflect the severity of the patient's condition or
complications that arise from multiple medical problems
D. Payors have the opportunity to benefit from the provider's cost savings
Answer: A

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NO.7 The Adobe Health Plan complies with all of the provisions of the Newborns' and Mothers'
Health Protection Act (NMHPA) of 1996. Kristen Netzger, an Adobe enrollee, was hospitalized for a
cesarean delivery. Amy Davis, also an Adobe enrollee, was hospitalized for a normal delivery. From
the following answer choices, select the response that indicates the minimum length of time for
which Adobe, under NMHPA, most likely must provide benefits for the hospitalizations of Ms.
Netzger and Ms. Davis.
A. Ms. Netzger = 48 hours Ms. Davis = 48 hours
B. Ms. Netzger = 72 hours Ms. Davis = 72 hours
C. Ms. Netzger = 96 hours Ms. Davis = 48 hours
D. Ms. Netzger = 96 hours Ms. Davis = 72 hours
Answer: C

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NO.8 With regard to the compensation of dental care providers in a managed dental care system, it is
correct to state that, typically:
A. dental PPOs compensate dentists on a capitated basis
B. group model dental HMOs (DHMOs) compensate general dental practitioners on a salaried basis
C. independent practice association (IPA)-model dental HMOs (DHMOs) capitate general dental
D. staff model dental HMOs (DHMOs) compensate dentists on an FFS basis
Answer: C

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Posted 2015/7/28 17:03:01  |  Category: AHIP  |  Tag: AHM-530 test answersAHIP