AHM-530 AHIP Network Management exact Exam Questions

Network Management

Last Update 19 hours ago Total Questions : 202

The Network Management content is now fully updated, with all current exam questions added 19 hours ago. Deciding to include AHM-530 practice exam questions in your study plan goes far beyond basic test preparation.

You'll find that our AHM-530 exam questions frequently feature detailed scenarios and practical problem-solving exercises that directly mirror industry challenges. Engaging with these AHM-530 sample sets allows you to effectively manage your time and pace yourself, giving you the ability to finish any Network Management practice test comfortably within the allotted time.

Question # 4

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.

In most states, a health plan can be held responsible for a provider’s negligent malpractice. This legal concept is known as (vicarious liability / risk sharing). One step that health plans can take to reduce their exposure to malpractice lawsuits is to state in health plan-provider agreements, marketing collateral, and membership literature that the providers are (employees of the health plan / independent contractors).

Vicarious liability / employees of the health plan

Vicarious liability / independent contractors

Risk sharing / employees of the health plan

Risk sharing / independent contractors

Question # 5

The following statements are about incentive programs used for providers. Select the answer choice containing the correct statement.

Risk pools based on aggregate provider performance eliminate problems associated with “free riders.”

A hospital bonus pool is usually split between the health plan and the PCPs.

Bonus pools based on the performance of specific providers are usually easier to administer than those based on the performance of the plan as a whole.

For providers, withhold arrangements eliminate the risk of losing base income.

Question # 6

The following statement(s) can correctly be made about the TRICARE managed healthcare program of the U.S. Department of Defense.

1. Active-duty military personnel are automatically enrolled in TRICARE’s HMO option (TRICARE Prime).

2. Eligible family members and dependents can enroll in TRICARE Prime, the PPO plan (TRICARE Extra), or an indemnity plan (TRICARE Standard).

Both 1 and 2

1 only

2 only

Neither 1 nor 2

Question # 7

In contracting with providers, a health plan can use a closed panel or open panel approach. One statement that can correctly be made about an open panel health plan is that the participating providers

must be employees of the health plan, rather than independent contractors

are prohibited from seeing patients who are members of other health plans

typically operate out of their own offices

operate according to their own standards of care, rather than standards of care established by the health plan

Question # 8

The Festival Health Plan is in the process of recruiting physicians for its provider network. Festival requires its network physicians to be board certified. The following individuals are provider applicants whose qualifications are being considered:

Applicant 1 has completed his surgical residency, and he recently passed a qualifying examination in his field.

Applicant 2 has completed her residency in dermatology, and she is scheduled to take qualifying examinations in the next Six months.

Applicant 3 completed his residency in pediatric medicine six years ago, but he has not yet passed a qualifying examination in his field.

With regard to these applicants, it can correctly be stated that only

Applicants 1 and 2 are board certified

Applicants 2 and 3 are board certified

Applicant 1 is board certified

Applicant 3 is board certified

Question # 9

In open panel contracting, there are several types of delivery systems. One such delivery system is the faculty practice plan (FPP). One likely result that a health plan will experience by contracting with an FPP is that the health plan will

be able to select most of the physicians in the FPP

achieve the highest level of cost effectiveness possible

experience limited control over utilization

achieve the most effective case management possible

Question # 10

Health plans often negotiate compensation arrangements that transfer some or all of the financial risk associated with delivering healthcare services to network providers. The following statements are about these compensation arrangements. Select the answer choice containing the correct statement.

A per diem system typically places a healthcare facility at risk for controlling utilization and costs internally.

One likely reason that an health plan would use a fee schedule system to compensate providers is that this system transfers most of the financial risk to the provider.

Under a salary system, a provider assumes no service risk.

The use of a FFS or a salary system allows an health plan to transfer a greater proportion of financial risk to providers than does the use of capitation.