Free AHM-530 Exam Braindumps

- (Topic 2)
The following statements are about network management for behavioral healthcare (BH). Three of these statements are true and one statement is false. Select the answer choice containing the FALSE statement.

1. A. Two measures of BH quality are patient satisfaction and clinical outcomes assessments.
2. B. For a health plan, one argument in favor of contracting with a managed behavioral healthcare organization (MBHO) is that the health plan's members can gain faster access to BH care.
3. C. In their contracts with health plans, managed behavioral healthcare organizations (MBHOs) usually receive delegated authority for network development and management.
4. D. Health plans generally compensate managed behavioral healthcare organizations (MBHOs) on an FFS basis.

Correct Answer: D

- (Topic 2)
The following activities are the responsibility of either the Nova Health Plan's risk management department or its medical management department:

1. A. Protecting Nova's members against harm from medical care
2. B. Improving the overall health status of Nova members by coordinating care across individual episodes of care and the different providers who treat the member
3. C. Protecting Nova against financial loss associated with the delivery of healthcare
4. D. Establishing outreach programs to encourage the use of preventive health services by Nova's members of these activities, the ones that are more likely to be the responsibility of Nova's risk management department rather than its medical management department are activities:
5. E. A, B, and C
6. F. A, C, and D
7. G. A and C
8. H. B and D

Correct Answer: C

- (Topic 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

1. A. Utilization management committee
2. B. Peer review committee
3. C. Medical advisory committee
4. D. Credentialing committee

Correct Answer: B

- (Topic 2)
With regard to the compensation of dental care providers in a managed dental care system, it is correct to state that, typically:

1. A. dental PPOs compensate dentists on a capitated basis
2. B. group model dental HMOs (DHMOs) compensate general dental practitioners on a salaried basis
3. C. independent practice association (IPA)-model dental HMOs (DHMOs) capitate general dental practitioners
4. D. staff model dental HMOs (DHMOs) compensate dentists on an FFS basis

Correct Answer: C

- (Topic 2)
The employees of the Trilogy Company are covered by a typical workers' compensation program. Under this coverage, Trilogy employees are bound by the exclusive remedy doctrine, which most likely:

1. A. Allows Trilogy to deny benefits for an employee's on-the-job injury or illness, but only if Trilogy is not at fault for the injury or illness.
2. B. Allows Trilogy to place limits on the amount of coverage payable for a given claim under the workers' compensation program.
3. C. Requires the employees to accept workers' compensation as their only compensation in cases of work-related injury or illness.
4. D. Provides the employees with 24-hour coverage.

Correct Answer: C