Free AHIP AHM-530 Exam Questions
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AHIP AHM-530 Exam Questions
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Provided By: AHIP
- Exam: Network Management (AHM530)
- Certification: AHIP Certification
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Total Questions: 205
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Updated On: Feb 17, 2025
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Rated: 4.9 |
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Online Users: 410
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Question 1
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Dr. Sylvia Cimer and Dr. Andrew Donne are obstetrician/gynecologists who participate in the sameprovider network. Dr. Comer treats a large number of high-risk patients, whereas Dr. Donne’spatients are generally healthy and rarely present complications. As a result, Dr. Comer typicallyuses medical resources at a much higher rate than does Dr. Donne. In order to equitably compareDr. Comer’s performance with Dr. Donne’s performance, the health plan modified its evaluation toaccount for differences in the providers’ patient populations and treatment protocols. The healthplan modified Dr. Comer’s and Dr. Donne’s performance data by means of
Answer: A
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Dr. Sylvia Cimer and Dr. Andrew Donne are obstetrician/gynecologists who participate in the sameprovider network. Dr. Comer treats a large number of high-risk patients, whereas Dr. Donne’spatients are generally healthy and rarely present complications. As a result, Dr. Comer typicallyuses medical resources at a much higher rate than does Dr. Donne. In order to equitably compareDr. Comer’s performance with Dr. Donne’s performance, the health plan modified its evaluation toaccount for differences in the providers’ patient populations and treatment protocols. The healthplan modified Dr. Comer’s and Dr. Donne’s performance data by means of
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Question 2
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The provider contract that Dr. Nick Mancini has with the Utopia Health Plan includes a clause that
requires Utopia to reimburse Dr. Mancini on a fee-for-service (FFS) basis until 100 Utopia
members have selected him as their primary care provider (PCP). At that time, Utopia will begin
reimbursing him under a capitated arrangement. This clause in Dr. Mancini's provider contract is
known as:
Answer: B
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The provider contract that Dr. Nick Mancini has with the Utopia Health Plan includes a clause that
requires Utopia to reimburse Dr. Mancini on a fee-for-service (FFS) basis until 100 Utopia
members have selected him as their primary care provider (PCP). At that time, Utopia will begin
reimbursing him under a capitated arrangement. This clause in Dr. Mancini's provider contract is
known as:
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Question 3
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One reimbursement method that health plans can use for hospitals is the ambulatory payment
classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs)
method of reimbursement. However, when comparing APCs and DRGs, one of the primary
differences between the two methods is that only the APC method
Answer: A
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One reimbursement method that health plans can use for hospitals is the ambulatory payment
classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs)
method of reimbursement. However, when comparing APCs and DRGs, one of the primary
differences between the two methods is that only the APC method
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Question 4
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The following statements are about workers' compensation provider networks. Select the answer
choice containing the correct statement:
Answer: D
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The following statements are about workers' compensation provider networks. Select the answer
choice containing the correct statement:
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Question 5
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The following paragraph contains an incomplete statement. Select the answer choice containing
the term that correctly completes the statement.
One important activity within the scope of network management is ensuring the quality of the
health plan’s provider networks. A primary purpose of __ __ is to review the
clinical competence of a provider in order to determine whether the provider meets the health
plan’s preestablished criteria for participation in the network.
Answer: C
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The following paragraph contains an incomplete statement. Select the answer choice containing
the term that correctly completes the statement.
One important activity within the scope of network management is ensuring the quality of the
health plan’s provider networks. A primary purpose of __ __ is to review the
clinical competence of a provider in order to determine whether the provider meets the health
plan’s preestablished criteria for participation in the network.