Free AHIP AHM-530 Exam Questions

Dr. Sylvia Cimer and Dr. Andrew Donne are obstetrician/gynecologists who participate in the sameprovider network. Dr. Comer treats a large number of high-risk patients, whereas Dr. Donne’spatients are generally healthy and rarely present complications. As a result, Dr. Comer typicallyuses medical resources at a much higher rate than does Dr. Donne. In order to equitably compareDr. Comer’s performance with Dr. Donne’s performance, the health plan modified its evaluation toaccount for differences in the providers’ patient populations and treatment protocols. The healthplan modified Dr. Comer’s and Dr. Donne’s performance data by means of 

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

A population’s demographic factors—such as income levels, age, gender, race, and ethnicity—can influence the design of provider networks serving that population. With respect to these demographic factors, it is correct to say that 

The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. One important activity within the scope of network management is ensuring the quality of the health plan’s provider networks. A primary purpose of __ __ is to review the clinical competence of a provider in order to determine whether the provider meets the health plan’s preestablished criteria for participation in the network.  

Promise, Inc., a corporation that specializes in cancer services, employs its physicians and support staff and provides facilities and ancillary services for cancer patients. Promise has contracted with the Cordelia Health Plan to provide all specialty services for Cordelia plan members who are undergoing cancer treatment. In return, Promise receives a capitated amount from Cordelia. Promise is an example of a type of specialty services organization known as a