Free AHM-520 Exam Braindumps

- (Topic 1)
The Challenger Group is a type of management services organization (MSO) that purchases the assets of physician practices, provides practice management andadministrative support servicesto participating providers, and offers physicians a long- term contract and an equity position in Challenger. This information indicates that Challenger is a type of health plan

1. A. Known as
2. B. An integrated delivery system (IDS)
3. C. Amedical foundation
4. D. Aprovider-sponsored organization (PSO)
5. E. Aphysician practice management (PPM) company

Correct Answer: D

- (Topic 1)
One law prohibits Dr. Laura Cole from making a referral to another provider entity for designated health services if Dr. Cole or one of her immediate family members has a financial relationship with the entity. This law is known as the

1. A. safe harbor law
2. B. upper payment limit law
3. C. anti-kickback law
4. D. physician self-referral law

Correct Answer: D

- (Topic 1)
The Atoll Health Plan must comply with a number of laws that directly affect the plan's contracts. One of these laws allows Atoll's plan members to receive medical services from certain specialists without first being referred to those specialists by a primary care provider (PCP). This law, which reduces the PCP's ability to manage utilization of these specialists, is known as ______.

1. A. A due process law
2. B. An any willing provider law
3. C. A direct access law
4. D. A fair procedure law

Correct Answer: C

- (Topic 1)
With regard to the Medicaid program in the United States, it can correctly be stated that

1. A. The federal government provides none of the funding for state Medicaid programs
2. B. Federal Medicaid law is different from Medicare law in that the federal government explicitly sets forth the methodology for payment of Medicaid-contracting plans but not Medicare-contracting plans
3. C. A state's payment to health plans for providing Medicaid services cannot be more than it would have cost the state to provide the services under Medicaid fee-for-service (FFS)
4. D. States are prohibited from carving out specific services from the capitation rate that health plans receive for providing Medicaid services

Correct Answer: C

- (Topic 2)
The following statement(s) can correctly be made about a health plan's cash receipts and cash disbursements budgets:

1. A. To predict both the timing and the amount of its cash receipts, a health plan constructs the cash receipts budget using data from its sales forecast and investment forecasts.
2. B. A health plan uses a cash disbursements budget in order to establish the amount, but not the timing, of all of its cash disbursements.
3. C. Both A and B
4. D. A only
5. E. B only
6. F. Neither A nor B

Correct Answer: B