Free AHM-530 Exam Braindumps

- (Topic 1)
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

1. A. is typically used for outpatient care
2. B. assigns a single code for treatment
3. C. applies to treatment received during an entire hospital stay
4. D. is considered to be a retrospective payment system

Correct Answer: A

- (Topic 1)
The National Association of Insurance Commissioners (NAIC) Managed Care Plan Network Adequacy Model Act defines specific adequacy and accessibility standards that health plans must meet. In addition, the Model Act requires health plans to

1. A. Hold plan members responsible for unreimbursed charges or unpaid claims
2. B. Allow providers to develop their own standards of care
3. C. Adhere to specified disclosure requirements related to provider contract termination
4. D. File written access plans and sample contracts with the Centers for Medicaid and Medicare Services (CMS)

Correct Answer: C

- (Topic 1)
From the following answer choices, choose the term that best matches the description.
Members of a physician-hospital organization (PHO) denied membership to a physician solely because the physician has admitting privileges at a competing hospital.

1. A. Group boycott
2. B. Horizontal division of territories
3. C. Tying arrangements
4. D. Concerted refusal to admit

Correct Answer: A

- (Topic 2)
Franklin Pitt selected a Medicare+Choice option under which he is covered by a catastrophic health insurance policy with a high annual deductible and a $6,000 out-of- pocket expense maximum. CMS pays the premiums for the insurance policy out of the usual Medicare+Choice payment and deposits any difference between the capitated amount and the policy premium in a savings account. Mr. Pitt can use funds in the savings account to pay qualified medical expenses not covered by his insurance policy. At the end of the benefit year, Mr. Pitt can carry any remaining funds into the next benefit year. The Medicare+Choice option Mr. Pitt selected is known as a

1. A. coordinate care plan (CCP)
2. B. medical savings account (MSA) plan
3. C. competitive medical plan (CMP)
4. D. Medicare Risk HMO program

Correct Answer: B

- (Topic 1)
From the following answer choices, choose the type of clause or provision described in this situation.
The Aviary Health Plan includes in its provider contracts a clause or provision that places the ultimate responsibility for an Aviary plan member’s medical care on the provider.

1. A. Cure provision
2. B. Hold-harmless provision
3. C. Evergreen clause
4. D. Exculpation clause

Correct Answer: D