Free AHIP AHM-530 Exam Questions

Question 1

Dr. Eve Barlow is a specialist in the Amity Health Plan’s provider network. Dr. Barlow’s provider contract with Amity contains a typical most-favored-nation arrangement. The purpose of this arrangement is to

A : Require Dr. Barlow and Amity to use arbitration to resolve any disputes regarding the contract

B : Specify that the contract is to be governed by the laws of the state in which Amity has its headquarters

C : Require Dr. Barlow to charge Amity her lowest rate for a medical service she has provided to an Amity plan member, even if the rate is lower than the price negotiated in the contract

D : State that the contract creates an employment or agency relationship, rather than an independent contractor relationship, between Dr. Barlow and Amity

Answer: C

Question 2

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that shecannot sue or file any claims against a Canyon plan member for covered services, even if Canyonbecomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyonwill compensate her under a typical discounted fee-for-service (DFFS) payment system.During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plandetermine how well she met Canyon's standards. The report included cumulative performancedata for Dr. Enberg and encompassed all measurable aspects of her performance. This reportincluded such information as the number of hospital admissions Dr. Enberg had and the number ofreferrals she made outside of Canyon's provider network during a specified period. Canyon alsoused process measures, structural measures, and outcomes measures to evaluate Dr. Enberg'sperformance.The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon planmember for covered services is known as:

A : Atermination with cause clause

B : Ahold-harmless clause

C : An indemnification clause

D : Acorrective action clause

Answer: B

Question 3

With respect to hiring practices, one step that a health plan most likely can take to avoid violating the terms of the Americans with Disabilities Act (ADA) is to

A : Require a medical examination prior to accepting an application for employment

B : Include in the employment application questions pertaining to health status

C : Make a conditional offer of employment, and then require the candidate to have an examination prior to granting specific staff privileges

D : Require applicants to answer questions pertaining to the use of drugs and alcohol

Answer: C

Question 4

Dr. Eve Barlow is a specialist in the Amity Health Plan’s provider network. Dr. Barlow’s provider contract with Amity contains a typical most-favored-nation arrangement. The purpose of this arrangement is to

A : Require Dr. Barlow and Amity to use arbitration to resolve any disputes regarding the contract

B : Specify that the contract is to be governed by the laws of the state in which Amity has its headquarters

C : Require Dr. Barlow to charge Amity her lowest rate for a medical service she has provided to an Amity plan member, even if the rate is lower than the price negotiated in the contract

D : State that the contract creates an employment or agency relationship, rather than an independent contractor relationship, between Dr. Barlow and Amity

Answer: C

Question 5

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

A : Specialty IPA

B : Disease management company

C : Single specialty management specialist

D : Specialty network management company

Answer: B