Free AHM-530 Exam Braindumps

- (Topic 2)
One true statement about the Employee Retirement Income Security Act of 1974 (ERISA) is that:

1. A. ERISA applies to all issuers of health insurance products, such as HMOs
2. B. pension plans and employee welfare plans are exempt from any regulation under ERISA
3. C. ERISA requires self-funded plans to comply with all state mandates affecting health insurance companies and health plans
4. D. the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans

Correct Answer: D

- (Topic 2)
The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:

1. A. In order to supply a provider network to furnish healthcare to workers' compensation beneficiaries, a health plan typically uses the network that has already been created for the group health plan.
2. B. Typically, case managers for workers' compensation programs are physical therapists.
3. C. Most states prohibit the use of fee schedules in order to curb the rising workers' compensation healthcare costs.
4. D. Networks serving workers' compensation patients typically include higher concentrations of specialists than do other provider networks.

Correct Answer: D

- (Topic 1)
Lakesha Frazier, a member of a health plan in a rural area, had been experiencing heart palpitations and shortness of breath. Ms. Frazier’s primary care provider (PCP) referred her to a local hospital for an electrocardiogram. The results of the electrocardiogram were transmitted for diagnosis via high-speed data transmission to a heart specialist in a city 500 miles away. This information indicates that the results of Ms. Frazier’s electrocardiogram were transmitted using a communications system known as

1. A. Anarrow network
2. B. An integrated healthcare delivery system
3. C. Telemedicine
4. D. Customized networking

Correct Answer: C

- (Topic 2)
A health plan that delegates designated credentialing activities to an NCQA-centered or a Commission/URAC-centered credentials verification organization (CVO) is exempt from the due-diligence oversight requirements specified in the NCQA credentialing standards for all
verification services for which the CVO has been certified:

1. A. True
2. B. False

Correct Answer: A

- (Topic 1)
Decide whether the following statement is true or false:
The organizational structure of a health plan’s network management function often depends on the size and geographic scope of the health plan. With respect to the size of a health plan, it is correct to say that smaller health plans typically have less integration and more specialization of roles than do larger health plans.

1. A. True
2. B. False

Correct Answer: B