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AHIP AHM-530 Exam Dumps

Vendor

CompTIA

Exam Code

AHM-530

Exam Name

Network Management

Exam Duration

Total Questions

202

$ 49

PDF VERSION

DEMO QUESTIONS

Q1: When evaluating the success of providers in meeting standards, a health plan must make adjustments for case mix or severity. One true statement about case mix/severity adjustments is that they:

A: Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists

B: Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient

C: Tend to increase the number of providers who are considered to be outliers

D: Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care

Correct Answer: B

Q2: The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that she cannot sue or file any claims against a Canyon plan member for covered services, even if Canyon becomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyon will compensate her under a typical discounted fee-for-service (DFFS) payment system. During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plan determine how well she met Canyon's standards. The report included cumulative performance data for Dr. Enberg and encompassed all measurable aspects of her performance. This report included such information as the number of hospital admissions Dr. Enberg had and the number of referrals she made outside of Canyon's provider network during a specified period. Canyon also used process measures, structural measures, and outcomes measures to evaluate Dr. Enberg's performance. Canyon used a process measure to evaluate the performance of Dr. Enberg when it evaluated whether:

A: Dr. Enberg's young patients receive appropriate immunizations at the right ages

B: Dr. Enberg's young patients receive appropriate immunizations at the right ages

C: The condition of one of Dr. Enberg's patients improved after the patient received medical treatment from Dr. Enberg

D: Dr. Enberg's procedures are adequate for ensuring patients' access to medical care

Correct Answer: A

Q3: When evaluating the success of providers in meeting standards, a health plan must make adjustments for case mix or severity. One true statement about case mix/severity adjustments is that they:

A: Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists

B: Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient

C: Tend to increase the number of providers who are considered to be outliers

D: Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care

Correct Answer: B

Q4: Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:

A: Upcoding

B: A wrap-around

C: Churning

D: Unbundling

Correct Answer: D

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