Download Network Management.AHM-530.RealExams.2019-03-15.121q.tqb

Vendor: AHIP
Exam Code: AHM-530
Exam Name: Network Management
Date: Mar 15, 2019
File Size: 514 KB

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Demo Questions

Question 1
Dr. Ahmad Shah and Dr. Shantelle Owen provide primary care services to Medicare+Choice enrollees of health plans under the following physician incentive plans:
Dr. Shah receives $40 per enrollee per month for providing primary care and an additional $10 per enrollee per month if the cost of referral services falls below a specified level 
Dr. Owen receives $30 per enrollee per month for providing primary care and an additional $15 per enrollee per month if the cost of referral services falls below a specified level 
The use of a physician incentive plan creates substantial risk for
  1. Both Dr. Shah and Dr. Owen
  2. Dr. Shah only
  3. Dr. Owen only
  4. Neither Dr. Shah nor Dr. Owen
Correct answer: C
Question 2
An increasing number of health plans offer coverage for alternative healthcare services. One such alternative healthcare service is biofeedback. Biofeedback is an approach that
  1. is based on an ancient Chinese system of healing in which needles are inserted into specific sites on the body to relieve pain
  2. treats diseases with tiny doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated
  3. uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate and body temperature
  4. incorporates a variety of therapies, such as homeopathy, lifestyle modification, and herbal medicines, to support and maintain the body's ability to heal itself
Correct answer: C
Question 3
The provider contract that the Danube Health Plan has with the Viola Home Health Services Organization states that Danube will use a typical flat rate reimbursement arrangement to compensate Viola for the skilled nursing services it provides to Danube's plan members. A portion of the contract's reimbursement schedule is shown below:
Home Health Licensed Practical Nurse (LPN): $45 per visit or $90 per diem
Home Health Registered Nurse (RN): $50 per visit or $110 per diem
Last month, an LPN from Viola visited a Danube plan member and provided 1Ѕ hours of home healthcare, and an RN from Viola visited another Danube plan member and provided 7 hours of home healthcare. The following statement(s) can correctly be made about Danube's payment to Viola for these services:
  1. Danube most likely owes $90 for the LPN's skilled nursing services and $110 for the RN's skilled nursing services.
  2. Danube's payment amount could be different from the amount called for in the reimbursement schedule if the level of care provided to one of these plan members was significantly different from the level of care normally provided by Viola's RNs and LPNs.
  3. Both A and B
  4. A only
  5. B only
  6. Neither A nor B
Correct answer: C

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