Free AHM-530 Exam Dumps

Question 26

- (Topic 1)
The Gladspell HMO has contracted with the Ellysium Hospital to provide subacute care to its plan members. Gladspell pays Ellysium by using a per diem reimbursement method.
If the Ellysium subacute care unit is typical of most hospital-based subacute skilled nursing units, then this unit could be used for patients who no longer need to be in the hospital’s acute care unit but who still require

A. Daily medical care and monitoring
B. Regular rehabilitative therapy
C. Respiratory therapy
D. All of the above

Correct Answer:D

Question 27

- (Topic 2)
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

Correct Answer:B

Question 28

- (Topic 1)
Some jurisdictions have enacted corporate practice of medicine laws. One effect that corporate practice of medicine laws have had on HMO provider networks is that these laws typically

A. require incorporated HMOs to practice medicine through licensed employees
B. require HMOs to form exclusive contracts with physician groups who agree to dedicate all or most of their practices to HMO patients in return for a set payment or revenue-sharing
C. restrict the ability of staff model HMOs to hire physicians directly, unless the physiciansown the HMO
D. encourage incorporated HMOs to obtain profits from their provisions of physician professional services

Correct Answer:C

Question 29

- (Topic 2)
If a member of the Green Health Plan reasonably believes that a provider in Green's provider network was acting as Green's employee or agent while providing negligent care, then the member may have cause to bring action against the health plan. This legal concept is known as vicarious liability. Steps that Green can take to reduce its exposure to vicarious liability claims include:

A. Placing restrictions on provider-member communication involving treatment decisions.
B. Implementing risk management and quality assurance programs for its provider network.
C. Including in its provider agreements and marketing and membership literature a statement that members of the Green provider network are not independent contractors.
D. All of the above.

Correct Answer:B

Question 30

- (Topic 2)
Partial capitation is one common approach to capitation. One typical characteristic of partial capitation is that it:

A. Includes only primary care services
B. Covers such services as immunizations and laboratory tests
C. Can be used only if the provider's panel size is less than 50 providers
D. Covers such services as cardiology and orthopedics

Correct Answer:A