Free AHM-530 Exam Braindumps

- (Topic 2)
The Pine Health Plan has incorporated pharmacy benefits management into its operations to form a unified benefit. Potential advantages that Pine can receive from this action include:

1. A. the fact that unified benefits improve the quality of patient care and the value of pharmacy services to Pine's plan members
2. B. the fact that control over the formulary and network contracting can give Pine control over patient access to prescription drugs and to pharmacies
3. C. the fact that managing pharmacy benefits in-house gives Pine a better chance to meet customer needs by integrating pharmacy services into the plan's total benefits package
4. D. all of the above

Correct Answer: D

- (Topic 2)
Dr. Ahmad Shah and Dr. Shantelle Owen provide primary care services to Medicare+Choice enrollees of health plans under the following physician incentive plans:
Dr. Shah receives $40 per enrollee per month for providing primary care and an additional
$10 per enrollee per month if the cost of referral services falls below a specified level
Dr. Owen receives $30 per enrollee per month for providing primary care and an additional
$15 per enrollee per month if the cost of referral services falls below a specified level The use of a physician incentive plan creates substantial risk for

1. A. Both D
2. B. Shah and D
3. C. Owen
4. D. D
5. E. Shah only
6. F. D
7. G. Owen only
8. H. Neither D
9. I. Shah nor D
10. J. Owen

Correct Answer: C

- (Topic 2)
The following situations illustrate violations of federal antitrust laws:
Situation A Two HMOs split a large employer group by agreeing to let one HMO market to some company employees and to let the second HMO market to different company employees.
Situation B Members of a physician-hospital organization (PHO) that has significant market share jointly agreed to exclude a physician from joining the PHO solely because that physician has admitting privileges at a competing hospital.
From the following answer choices, select the response that best identifies the types of violations illustrated by these situations:

1. A. Situation A: horizontal division of territories; Situation B: group boycott
2. B. Situation A: horizontal division of territories; Situation B: exclusive arrangement
3. C. Situation A: exclusive arrangement; Situation B: group boycott
4. D. Situation A: exclusive arrangement; Situation B: tying arrangement

Correct Answer: A

- (Topic 1)
The introductory paragraph of a provider contract is generally followed by a section called the recitals. The recitals section of the contract typically specifies the

1. A. Purpose of the agreement
2. B. Manner in which the provider is to bill for services
3. C. Definitions of key terms to be used in the contract
4. D. Rate at which the provider will be compensated

Correct Answer: A

- (Topic 1)
Promise, Inc., a corporation that specializes in cancer services, employs its physicians and support staff and provides facilities and ancillary services for cancer patients. Promise has contracted with the Cordelia Health Plan to provide all specialty services for Cordelia plan members who are undergoing cancer treatment. In return, Promise receives a capitated amount from Cordelia. Promise is an example of a type of specialty services organization known as a

1. A. Specialty IPA
2. B. Disease management company
3. C. Single specialty management specialist
4. D. Specialty network management company

Correct Answer: B