AHM-530 AHIP Exam Questions and Free Practice Test

Question 50

- (Topic 2)
The Edgewood Health Plan uses a combination of structural, process, outcomes, and customer satisfaction measures to evaluate its network providers’ performance. Edgewood would correctly use outcomes measures to evaluate a provider’s

A. Compliance with specific regulatory or accrediting requirement

B. Appropriate use of specified procedures

C. Patient progress following treatment

D. Patient perceptions about how well the provider addresses medical problems

Correct Answer:C

Question 51

- (Topic 1)
By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as

A. Network management

B. Quality

C. Cost-effectiveness

D. Accessibility

Correct Answer:D

Question 52

- (Topic 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

A. is based on an ancient Chinese system of healing in which needles are inserted into specific sites on the body to relieve pain

B. treats diseases with tiny doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated

C. uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate and body temperature

D. 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 53

- (Topic 2)
Dr. Michelle Kubiak has contracted with the Gem Health Plan, a Medicare+Choice health plan, to provide medical services to Gem's enrollees. Gem pays Dr. Kubiak $40 per enrollee per month for providing primary care. Gem also pays her an additional $10 per enrollee per month if the cost of referral services falls below a targeted level. This information indicates that, according to the substantial financial risk formula, Dr. Kubiak's referral risk under this contract is equal to:

A. 20%, and therefore this arrangement puts her at substantial financial risk

B. 20%, and therefore this arrangement does not put her at substantial financial risk

C. 25%, and therefore this arrangement puts her at substantial financial risk

D. 25%, and therefore this arrangement does not put her at substantial financial risk

Correct Answer:B

Question 54

- (Topic 2)
The following statements are about fee-for-service (FFS) payment systems. Select the answer choice containing the correct statement:

A. A discounted fee-for-service (DFFS) system is usually easier for a health plan to administer than is a fee schedule system.

B. A case rate payment system offers providers an incentive to take an active role in managing cost and utilization.

C. One reason that health plans use a relative value scale (RVS) payment system is that RVS values for cognitive services have traditionally been higher than the values for procedural services.

D. One reason that health plans use a resource-based relative value scale (RBRVS) is that this system includes weighted unit values for all types of procedures.