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Exam Code: AHM-250Exam Name: Healthcare Management: An Introduction
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AHM-250 PDF VCE Total Q&A: 367 Questions and Answers
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Exam Code: AHM-530Exam Name: Network Management
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AHM-530 Exam PDF Total Q&A: 202 Questions and Answers
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Exam Code: AHM-520Exam Name: Health Plan Finance and Risk Management
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AHM-520 Test Questions Total Q&A: 215 Questions and Answers
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NO.1 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
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NO.2 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
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NO.3 In 1996, the NAIC adopted a standard for health plan coverage of emergency services. This
standard is based on a concept known as the:
A. Due process standard
B. Subrogation standard
C. Corrective action standard
D. Prudent layperson standard
Answer: D
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NO.4 One true statement about the compensation arrangement known as the case rate system is
that, under this system,
A. Providers stand to gain or lose based on the number and types of treatments used for each case
B. Providers have no incentives to take an active role in managing cost and utilization
C. Payors cannot adjust standard case rates to reflect the severity of the patient's condition or
complications that arise from multiple medical problems
D. Payors have the opportunity to benefit from the provider's cost savings
Answer: A
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NO.5 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
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NO.6 The following statement(s) can correctly be made about contracting and reimbursement of
specialty care physicians (SCPs):
A. Typically, a health plan should attempt to control utilization of SCPs before attempting to place
these providers under a capitation arrangement.
B. Forms of specialty physician reimbursement used by health plans include a retainer and a bundled
case rate.
C. Both A and B
D. A only
E. B only
F. Neither A nor B
Answer: A
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NO.7 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
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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
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