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
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