Most Recent AHIP AHM-530 Exam Questions & Answers

Prepare for the AHIP Network Management exam with our extensive collection of questions and answers. These practice Q&A are updated according to the latest syllabus, providing you with the tools needed to review and test your knowledge.

QA4Exam focus on the latest syllabus and exam objectives, our practice Q&A are designed to help you identify key topics and solidify your understanding. By focusing on the core curriculum, These Questions & Answers helps you cover all the essential topics, ensuring you're well-prepared for every section of the exam. Each question comes with a detailed explanation, offering valuable insights and helping you to learn from your mistakes. Whether you're looking to assess your progress or dive deeper into complex topics, our updated Q&A will provide the support you need to confidently approach the AHIP AHM-530 exam and achieve success.

The questions for AHM-530 were last updated on Nov 18, 2024.

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Question No. 1

If the Oconee Health Plan reimburses its specialty care physicians (SCPs) under a typical retainer method, then Oconee pays SCPs

AAseparate amount for each service provided, and the payment amount is based solely on a resource-based relative value scale (RBRVS)

BAspecified fee that remains the same regardless of how much or how little time or effort is spent on the medical service performed

CAset amount each month, and Oconee reconciles its payment at periodic intervals on the basis of actual utilization

DAset amount of cash equivalent to a defined time period's expected reimbursable charges

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Correct Answer: C

Question No. 2

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:

AIn order to supply a provider network to furnish healthcare to workers' compensation beneficiaries, a health plan typically uses the network that has already been created for the group health plan.

BTypically, case managers for workers' compensation programs are physical therapists.

CMost states prohibit the use of fee schedules in order to curb the rising workers' compensation healthcare costs.

DNetworks serving workers' compensation patients typically include higher concentrations of specialists than do other provider networks.

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Correct Answer: D

Question No. 3

The following statement(s) can correctly be made about contracting and reimbursement of specialty care physicians (SCPs):

ATypically, a health plan should attempt to control utilization of SCPs before attempting to place these providers under a capitation arrangement.

BForms of specialty physician reimbursement used by health plans include a retainer and a bundled case rate.

CBoth A and B

DA only

EB only

FNeither A nor B

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Correct Answer: A

Question No. 4

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.

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

BOne 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.

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

DThe 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.

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Correct Answer: A

Question No. 5

The two basic approaches that Medicaid uses to contract with health plans are open contracting and selective contracting. One true statement about these approaches to contracting is that:

AOpen contracting requires health plans to meet minimum performance standards outlined in a state's request for proposal (RFP)

BOpen contracting makes it possible for the Medicaid agency to offer enrollment volume guarantees

CSelective contracting requires any health plan that meets the state's performance standards and the federal Medicaid requirements to enter into a Medicaid contract

DSelective contracting requires health plans to bid competitively for Medicaid contracts

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Correct Answer: D

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