Free AHM-530 Exam Braindumps

- (Topic 1)
Network managers rely on a health plan’s claims administration department for much of the information needed to manage the performance of providers who are not under a capitation arrangement. Examining claims submitted to a health plan’s claims administration department enables the health plan to

1. A. determine the number of healthcare services delivered to plan members
2. B. monitor the types of services provided by the health plan’s entire provider network
3. C. evaluate providers’ practice patterns and compliance with the health plan’s procedures for the delivery of care
4. D. all of the above

Correct Answer: D

- (Topic 1)
The following statements are about incentive programs used for providers. Select the answer choice containing the correct statement.

1. A. Risk pools based on aggregate provider performance eliminate problems associated with “free riders.”
2. B. A hospital bonus pool is usually split between the health plan and the PCPs.
3. C. Bonus pools based on the performance of specific providers are usually easier to administer than those based on the performance of the plan as a whole.
4. D. For providers, withhold arrangements eliminate the risk of losing base income.

Correct Answer: B

- (Topic 2)
With regard to the laws and regulations on access and adequacy of provider networks, it can correctly be stated that:

1. A. most access and adequacy guidelines relate to preferred provider organizations (PPOs) or managed indemnity products
2. B. corporate practice of medicine laws require staff model HMOs to hire physicians directly,even if the physicians do not own the HMO
3. C. any willing provider laws prevent a health plan from making exclusive or semi-exclusive arrangements with a provider or a group of providers
4. D. the NAIC Managed Care Plan Network Adequacy Model Act requires states to use provider-enrollee ratios as the sole measure of network adequacy

Correct Answer: C

- (Topic 1)
The following statements are about managed dental care. Three of these statements are true, and one is false. Select the answer choice containing the FALSE statement.

1. A. Managed dental care is federally regulated.
2. B. Dental HMOs typically need very few healthcare facilities because almost all dental services are delivered in an ambulatory care setting.
3. C. Currently, there are no nationally recognized standards for quality in managed dental care.
4. D. Processes for selecting dental care providers vary greatly according to state regulationson managed dental care networks and the health plan’s standards.

Correct Answer: A

- (Topic 1)
If a third party is responsible for injuries to a plan member of the Hope Health Plan, then Hope has a contractual right to file a claim for the resulting healthcare costs against the third party. This contractual right to recovery from the third party is known as

1. A. Subrogation
2. B. Partial capitation
3. C. Coordination of benefits
4. D. Aremedy provision

Correct Answer: A