Free AHIP AHM-530 Exam Questions

One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement. However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method  

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

The following statement(s) can correctly be made about hospitalists.1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure thatthe patient receives appropriate care while in the hospital.2. The hospitalist’s role clearly supports the health plan concept of disease management. 

The Ionic Group, a provider group with 10,000 plan members, purchased for its hospital risk pool aggregate stop-loss insurance with a threshold of 110% of projected costs and a 10% coinsurance provision. Ionic funds the hospital risk pool at $40 per member per month (PMPM). If Ionic’s actual hospital costs are $5,580,000 for the year, then, under the aggregate stop-loss agreement, the stop-loss insurer is responsible for reimbursing Ionic in the amount of

The following statement(s) can correctly be made about hospitalists.1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure thatthe patient receives appropriate care while in the hospital.2. The hospitalist’s role clearly supports the health plan concept of disease management.