NO.1 The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that she
cannot sue or file any claims against a Canyon plan member for covered services, even if Canyon
becomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyon
will compensate her under a typical discounted fee-for-service (DFFS) payment system.
During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plan
determine how well she met Canyon's standards. The report included cumulative performance data
for Dr. Enberg and encompassed all measurable aspects of her performance. This report included
such information as the number of hospital admissions Dr. Enberg had and the number of referrals
she made outside of Canyon's provider network during a specified period. Canyon also used process
measures, structural measures, and outcomes measures to evaluate Dr. Enberg's performance.
Canyon used a process measure to evaluate the performance of Dr. Enberg when it evaluated
whether:
A. Dr. Enberg's young patients receive appropriate immunizations at the right ages
B. Dr. Enberg's young patients receive appropriate immunizations at the right ages
C. The condition of one of Dr. Enberg's patients improved after the patient received medical
treatment from Dr. Enberg
D. Dr. Enberg's procedures are adequate for ensuring patients' access to medical care
Answer: A
AHIP専門知識 AHM-530監査ツール AHM-530認定試験 AHM-530独学
NO.2 Health plans typically conduct two types of reviews of a provider's medical records: an
evaluation of the provider's medical record keeping (MRK) practices and a medical record review
(MRR). One true statement about these types of reviews is that:
A. An MRK covers the content of specific patient records of a provider.
B. The NCQA requires an examination of MRK with all of a health plan's office evaluations.
C. An MRR includes a review of the policies, procedures, and documentation standards the provider
follows to create and maintain medical records.
D. The NCQA requires MRR for both credentialing and recredentialing of providers in a health plan's
network.
Answer: A
AHIPトレーニング資料 AHM-530ソートキー AHM-530改訂 AHM-530返金 AHM-530技術試験 AHM-530リンクグローバル
NO.3 The Adobe Health Plan complies with all of the provisions of the Newborns' and Mothers'
Health Protection Act (NMHPA) of 1996. Kristen Netzger, an Adobe enrollee, was hospitalized for a
cesarean delivery. Amy Davis, also an Adobe enrollee, was hospitalized for a normal delivery. From
the following answer choices, select the response that indicates the minimum length of time for
which Adobe, under NMHPA, most likely must provide benefits for the hospitalizations of Ms.
Netzger and Ms. Davis.
A. Ms. Netzger = 48 hours Ms. Davis = 48 hours
B. Ms. Netzger = 72 hours Ms. Davis = 72 hours
C. Ms. Netzger = 96 hours Ms. Davis = 48 hours
D. Ms. Netzger = 96 hours Ms. Davis = 72 hours
Answer: C
AHIP体験 AHM-530資格問題集 AHM-530受験方法 AHM-530受験
NO.4 Under the compensation arrangement that the Falcon Health Plan has with some of its
providers, Falcon holds back 10% of the negotiated payments to these providers in order to offset or
pay for any claims that exceed the budgeted costs for referral or hospital services. If the providers
keep costs within the budgeted amount, Falcon distributes to them the entire amount of money held
back. This way of motivating providers to control costs while providing high-quality, appropriate care
is known as a:
A. Risk pool arrangement
B. Withhold arrangement
C. Cost-shifting arrangement
D. Bonus pool arrangement
Answer: B
AHIP合格点 AHM-530資格取得 AHM-530改訂 AHM-530アクセスリスト
NO.5 With regard to the compensation of dental care providers in a managed dental care system, it is
correct to state that, typically:
A. dental PPOs compensate dentists on a capitated basis
B. group model dental HMOs (DHMOs) compensate general dental practitioners on a salaried basis
C. independent practice association (IPA)-model dental HMOs (DHMOs) capitate general dental
practitioners
D. staff model dental HMOs (DHMOs) compensate dentists on an FFS basis
Answer: C
AHIP資格取得講座 AHM-530認定資格 AHM-530市販本 AHM-530学習指導 AHM-530問題と解答
NO.6 In the paragraph below, two statements each contain a pair of terms enclosed in parentheses.
Determine which term correctly completes each statement. Then select the answer choice that
contains the two terms you have chosen.
In most states, a health plan can be held responsible for a provider's negligent malpractice. This legal
concept is known as (vicarious liability / risk sharing). One step that health plans can take to reduce
their exposure to malpractice lawsuits is to state in health plan-provider agreements,marketing
collateral, and membership literature that the providers are (employees of the health plan /
independent contractors).
A. Vicarious liability / employees of the health plan
B. Vicarious liability / independent contractors
C. Risk sharing / employees of the health plan
D. Risk sharing / independent contractors
Answer: B
AHIP返済 AHM-530市販本 AHM-530ラーニング AHM-530学校 AHM-530受験期
NO.7 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
A. Utilization management committee
B. Peer review committee
C. Medical advisory committee
D. Credentialing committee
Answer: B
AHIP受験記 AHM-530受験生 AHM-530 AHM-530学習教材
NO.8 The Portway Hospital is qualified to receive Medicaid subsidy payments as a disproportionate
share hospital (DHS). The DHS payments that Portway receives are
A. Made for services rendered to specific patients
B. Made with matching state and federal funds
C. Included in the Medicaid capitation payment made to patients' health plans
D. Defined as cost-based reimbursement (CBR) equal to 100% of Portway's reasonable costs of
providing services to Medicaid recipients
Answer: B
AHIP返金 AHM-530 AHM-530 AHM-530教本 AHM-530教本
JapanCertが提供した研修ツールはAHIPのAHM-540の認定試験に向けて学習資料やシミュレーション訓練宿題で、重要なのは試験に近い練習問題と解答を提供いたします。JapanCert を選ばれば短時間にITの知識を身につけることができて、高い点数をとられます。
空想は人間が素晴らしいアイデアをたくさん思い付くことができますが、行動しなければ何の役に立たないのです。AHIPのAHM-530認定試験に合格のにどうしたらいいかと困っているより、パソコンを起動して、JapanCertをクリックしたほうがいいです。JapanCertのトレーニング資料は１００パーセントの合格率を保証しますから、あなたのニーズを満たすことができます。
JapanCertはAHM-540認定試験に対する短期で有効な訓練を提供するウェブサイト、AHM-540認定試験が生活の変化をもたらすテストでございます。合格書を持ち方が持たない人により高い給料をもうけられます。
AHIPのAHM-530認定試験を受験するあなたは、試験に合格する自信を持たないですか。それでも恐れることはありません。JapanCertはAHM-530認定試験に対する最高な問題集を提供してあげますから。JapanCertの AHM-530問題集は最新で最全面的な資料ですから、きっと試験に受かる勇気と自信を与えられます。これは多くの受験生に証明された事実です。
AHM-530はAHIPの一つ認証試験として、もしAHIP認証試験に合格してIT業界にとても人気があってので、ますます多くの人がAHM-530試験に申し込んで、AHM-530試験は簡単ではなくて、時間とエネルギーがかかって用意しなければなりません。
逆境は人をテストすることができます。困難に直面するとき、勇敢な人だけはのんびりできます。あなたは勇敢な人ですか。もしIT認証の準備をしなかったら、あなたはのんびりできますか。もちろんです。 JapanCertのAHIPのAHM-530試験トレーニング資料を持っていますから、どんなに難しい試験でも成功することができます。
購入前にお試し,私たちの試験の質問と回答のいずれかの無料サンプルをダウンロード：http://www.japancert.com/AHM-530.html