Free AHM-530 Exam Dumps

Question 36

- (Topic 2)
The actual number of providers included in a provider network can be based on staffing ratios. One true statement about staffing ratios is that, typically:

A. A small health plan needs fewer physicians per 1,000 than does a large plan.
B. A closely managed health plan requires fewer providers than does a loosely managedplan.
C. Physician-to-enrollee ratios can be used directly only by network-within-a-network model HMOs.
D. Medicare products require fewer providers than do employer-sponsored plans of the same size.

Correct Answer:B

Question 37

- (Topic 2)
One true statement about the responsibilities of providers under typical provider contracts is that most provider contracts:

A. include a clause which states that providers must maintain open communications with patients regarding appropriate treatment plans, unless the services are not covered by the member's health plan
B. hold that the responsibility of the provider to deliver services is usually subject to theprovider's receipt of information regarding the eligibility of the member
C. contain a gag clause or a gag rule
D. include a clause that explicitly places the responsibility for medical care on the health plan rather than on the provider of medical services

Correct Answer:B

Question 38

- (Topic 1)
The Gardenia Health Plan has a national reputation for quality care. When Gardenia entered a new market, it established a preferred provider organization (PPO), a health maintenance organization (HMO), and a point-of-service product (POS) to serve the plan members in this market. All of the providers included in the HMO or the POS are included in the broader provider panel of the PPO. The POS will be a typical two-level POS that offers a cost-based incentive plans for PCPs, and the HMO is a typical staff model HMO.
One statement that can correctly be made about Gardenia’s two-level POS product is that

A. members who self-refer without first seeing their PCPs will receive no benefits
B. both Gardenia and the PCPs stand to benefit if the non-provider panels are kept relatively narrow
C. members will pay higher coinsurance or copayments if they first see their PCPs each time
D. the plan offers no financial incentives to members to choose an in-network specialist over a non-network specialist

Correct Answer:D

Question 39

- (Topic 2)
The Medicaid program subsidizes indigent care through payments to disproportionate share hospitals (DSHs). The Preamble Hospital is a DSH. As a DSH, Preamble most likely:

A. Receives financial assistance from the federal government but not a state government.
B. Is at a higher risk of operating at a loss than are most other hospitals.
C. Receives no payments directly from Medicaid for services rendered but rather receives a portion of the capitation payment that Medicaid makes to the health plans with which Preamble contracts.
D. Is eligible for capitation rates that are significantly higher than the FFS average for all covered Medicaid services.

Correct Answer:B

Question 40

- (Topic 1)
Health plan contract negotiations with an integrated delivery system (IDS) or a hospital are usually lengthier and more complex than negotiations with a single-specialty provider.

A. True
B. False

Correct Answer:A