Free AHM-530 Exam Dumps

Question 6

- (Topic 1)
The Avignon Company discontinued its contract with a traditional indemnity insurer and contracted exclusively with the Minaret Health Plan to provide the sole healthcare plan to Avignon’s employees. By agreeing to an exclusive contract with Minaret, Avignon has entered into a type of healthcare contract known as

A. a carrier guarantee arrangement
B. open access
C. total replacement coverage
D. selective contract coverage

Correct Answer:C

Question 7

- (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.

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

Correct Answer:A

Question 8

- (Topic 1)
Decide whether the following statement is true or false:
The organizational structure of a health plan’s network management function often depends on the size and geographic scope of the health plan. With respect to the size of a health plan, it is correct to say that smaller health plans typically have less integration and more specialization of roles than do larger health plans.

A. True
B. False

Correct Answer:B

Question 9

- (Topic 1)
Although a health plan is allowed to delegate many activities to outside sources, the National Committee for Quality Assurance (NCQA) has determined that some activities are not delegable.
These activities include

A. evaluation of new medical technologies
B. overseeing delegated medical records activities
C. developing written statements of members’ rights and responsibilities
D. all of the above

Correct Answer:D

Question 10

- (Topic 2)
The following statements are about fee-for-service (FFS) payment systems. Select the answer choice containing the correct statement:

A. A discounted fee-for-service (DFFS) system is usually easier for a health plan to administer than is a fee schedule system.
B. A case rate payment system offers providers an incentive to take an active role in managing cost and utilization.
C. One reason that health plans use a relative value scale (RVS) payment system is that RVS values for cognitive services have traditionally been higher than the values for procedural services.
D. One reason that health plans use a resource-based relative value scale (RBRVS) is that this system includes weighted unit values for all types of procedures.

Correct Answer:B