Free AHM-530 Exam Dumps

Question 11

- (Topic 1)
Salvatore Arris is a member of the Crescent Health Plan, which provides its members with a full range of medical services through its provider network. After suffering from debilitating headaches for several days, Mr. Arris made an appointment to see Neal Prater, a physician’s assistant in the Crescent network who provides primary care under the supervision of physician Dr. Anne Hunt. Mr. Prater referred Mr. Arris to Dr. Ginger Chen, an ophthalmologist, who determined that Mr. Arris’ symptoms were indicative of migraine headaches. Dr. Chen prescribed medicine for Mr. Arris, and Mr. Arris had the prescription filled at a pharmacy with which Crescent has contracted. The pharmacist, Steven Tucker, advised Mr. Arris to take the medicine with food or milk. In this situation, the person who functioned as an ancillary service provider is

A. M
B. Prater
C. D
D. Hunt
E. D
F. Chen
G. M
H. Tucker

Correct Answer:D

Question 12

- (Topic 2)
The Elizabethan Health Plan uses a direct referral program, which means that

A. PCPs in Elizabethan’s network can make most referrals without obtaining prior authorization from Elizabethan
B. PCPs in Elizabethan’s network must always refer plan members to other specialists within the network
C. Elizabethan’s plan members can bypass the PCP and obtain medical services from a specialist without a referral
D. Elizabethan’s plan members must obtain referrals directly from Elizabethan

Correct Answer:A

Question 13

- (Topic 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.

Correct Answer:A

Question 14

- (Topic 2)
State Medicaid agencies can contract with health plans through open contracting or selective contracting. One advantage of selective contracting is that it

A. Allows enrollees to choose from among a greater variety of health plans
B. Reduces the competition among health plans
C. Increases the ability of new, local plans to participate in Medicaid programs
D. Encourages the development of products that offer enhanced benefits and more effective approaches to health plans

Correct Answer:D

Question 15

- (Topic 1)
Determine whether the following statement is true or false:
The NCQA has established a Physician Organization Certification (POC) program for the purpose of certifying medical groups and independent practice associations for delegation of certain NCQA standards, including data collection and verification for credentialing and recredentialing.

A. True
B. False

Correct Answer:A