Free AHM-530 Exam Braindumps

- (Topic 2)
The Bruin Health Plan is a Social Health Maintenance Organization (SHMO). As an SHMO, Bruin:

1. A. Must provide Medicare participants with standard HMO benefits, as well as with limited long-term care benefits
2. B. Does not need as great a variety of provider types or as complex a reimbursement method as does a traditional HMO
3. C. Receives a payment that is based on reasonable costs and reasonable charges
4. D. Most likely provides fewer supportive services than does a traditional HMO, because one of Bruin's goals is to minimize the use of community-based care

Correct Answer: A

- (Topic 2)
Prior to the enactment of the Balanced Budget Act (BBA) of 1997, payment for Medicare- covered primary and acute care services was based on the adjusted average per capita cost (AAPCC). The AAPCC is defined as the

1. A. average cost of services delivered to all patients living in a specified geographic region
2. B. actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits
3. C. fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status
4. D. average fixed monthly fee paid by all Medicare enrollees in a specified geographic region

Correct Answer: C

- (Topic 2)
The Argyle Health Plan has contracted to obtain the services of the providers in the Column Medical Group, a faculty practice plan (FPP). The following statement(s) can correctly be made about this contract:

1. A. Column most likely contracted with the legal group representing the FPP rather than with the individual physicians within the FPP.
2. B. Column most likely will provide only highly specialized care to Argyle's plan members.
3. C. Both A and B
4. D. A only
5. E. B only
6. F. Neither A nor B

Correct Answer: B

- (Topic 1)
With respect to contractual provisions related to provider-patient communications, nonsolicitation clauses prohibit providers from

1. A. Encouraging patients to switch from one health plan to another
2. B. Disclosing confidential information about the health plan’s reimbursement structure
3. C. Dispersing confidential financial information regarding the health plan
4. D. Discussing alternative treatment plans with patients

Correct Answer: A

- (Topic 1)
The following statements can correctly be made about the advantages and disadvantages to an health plan of using the various delivery options for pharmacy services.

1. A. A disadvantage of using open pharmacy networks is that the health plan’s control over costs is limited to setting reimbursement levels.
2. B. An advantage of using performance-based systems is that they tend to increase participation in the health plan’s pharmacy network.
3. C. A disadvantage of using customized pharmacy networks is that these networks typically can be implemented only in companies with fewer than 500 employees.
4. D. All of these statements are correct.

Correct Answer: A