AHIP AHM-530 Exam Dumps and Updated Info

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AHIP AHM-530 Exam Dumps

AHIP AHM-530 Exam Dumps

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Description

Exam Name: Network Management

Exam Code: AHM-530

Related Certification(s): AHIP Network Management Certification

Certification Provider: AHIP

Actual Exam Duration: 120 Minutes

Number of AHM-530 practice questions in our database:

Expected AHM-530 Exam Topics, as suggested by AHIP :

Module 1: Map out how health insurance providers select, contract with, and compensate specialists and health care facilities/ Learn the process for network provider selection
Module 2: Recognize special requirements that affect network management for Medicare, Medicaid, and workers’ compensation networks
Module 3: Gain a detailed understanding of the scope and organization of the network management function within health insurance provider organizations
Module 4: Explore how health insurance providers ensure their provider networks remain adequate to meet member needs/ Understand how network strategies improve access, quality, and cost-effectiveness
Module 5: Identify the primary responsibilities and obligations of health insurance providers and health care providers under a provider contract
Module 6: Master the essential elements of a contractual relationship between health insurance providers and health care providers

Description
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Description

Exam Name: Network Management

Exam Code: AHM-530

Related Certification(s): AHIP Network Management Certification

Certification Provider: AHIP

Actual Exam Duration: 120 Minutes

Number of AHM-530 practice questions in our database:

Expected AHM-530 Exam Topics, as suggested by AHIP :

Module 1: Map out how health insurance providers select, contract with, and compensate specialists and health care facilities/ Learn the process for network provider selection
Module 2: Recognize special requirements that affect network management for Medicare, Medicaid, and workers’ compensation networks
Module 3: Gain a detailed understanding of the scope and organization of the network management function within health insurance provider organizations
Module 4: Explore how health insurance providers ensure their provider networks remain adequate to meet member needs/ Understand how network strategies improve access, quality, and cost-effectiveness
Module 5: Identify the primary responsibilities and obligations of health insurance providers and health care providers under a provider contract
Module 6: Master the essential elements of a contractual relationship between health insurance providers and health care providers

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Q1. When evaluating the success of providers in meeting standards, a health plan must make adjustments for case mix or severity. One true statement about case mix/severity adjustments is that they:

A.Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists

B. Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient

C. Tend to increase the number of providers who are considered to be outliers

D. Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care

Answer

Correct Answer: B

Q2. 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

Correct Answer: A

Q3. When evaluating the success of providers in meeting standards, a health plan must make adjustments for case mix or severity. One true statement about case mix/severity adjustments is that they:

A.Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists

B. Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient

C. Tend to increase the number of providers who are considered to be outliers

D. Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care

Answer

Correct Answer: B

Q4. Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:

A.Upcoding

B. A wrap-around

C. Churning

D. Unbundling

Answer

Correct Answer: D

Answer

Answer

Answer

Answer

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