Free AHM-530 Exam Dumps

Question 41

- (Topic 2)
The Edgewood Health Plan uses a combination of structural, process, outcomes, and customer satisfaction measures to evaluate its network providers’ performance. Edgewood would correctly use outcomes measures to evaluate a provider’s

A. Compliance with specific regulatory or accrediting requirement
B. Appropriate use of specified procedures
C. Patient progress following treatment
D. Patient perceptions about how well the provider addresses medical problems

Correct Answer:C

Question 42

- (Topic 2)
The following statement(s) can correctly be made about the Balanced Budget Act (BBA) of 1997:

A. The BBA requires Medicare+Choice organizations to be licensed as non-risk-bearing entities under federal law.
B. The Centers for Medicaid and Medicare Services (CMS) is responsible for implementing the BBA.
C. Both A and B
D. A only
E. B only
F. Neither A nor B

Correct Answer:C

Question 43

- (Topic 2)
As an authorized Medicare+Choice plan, the Brightwell HMO must satisfy CMS requirements regulating access to covered services. In order to ensure that its network provides adequate access, Brightwell must

A. Allow enrollees to determine whether they will receive primary care from a physician, nurse practitioner, or other qualified network provider
B. Base a provider’s participation in the network, reimbursement, and indemnification levels on the provider’s license or certification
C. Define its service area according to community patterns of care
D. Require enrollees to obtain prior authorization for all emergency or urgently needed services

Correct Answer:C

Question 44

- (Topic 1)
To protect providers against business losses, many health plan-provider contracts include carve-out provisions to help providers manage financial risk. The following statements are examples of such provisions:
The Apex Health Plan carves out immunizations from PCP capitations. Apex compensates PCPs for immunizations on a case rate basis.
The Bengal Health Plan carves out behavioral healthcare services from the scope of PCP services because these services require specialized knowledge and skills that most PCPs do not possess.
From the answer choices below, select the response that best identifies the types of carve- outs used by Apex and Bengal.

A. Apex: disease-specific carve-out Bengal: specialty services carve-out
B. Apex: disease-specific carve-out Bengal: specific-service carve-out
C. Apex: specific-service carve-out Bengal: specialty services carve-out
D. Apex: specific-service carve-out Bengal: disease-specific carve-out

Correct Answer:C

Question 45

- (Topic 1)
The actual number of providers included in a provider network may be based on staffing ratios. Staffing ratios relate the number of

A. Potential providers in a plan’s network to the number of individuals in the area to be served by the plan
B. Providers in a plan’s network to the number of enrollees in the plan
C. Providers outside a plan’s network to the number of providers in the plan’s network
D. Support staff in a plan’s network to the number of medical practitioners in the plan’s network

Correct Answer:B