AHM-530 Exam Dumps : Network Management

Made for services rendered to specific patients

Made with matching state and federal funds

Included in the Medicaid capitation payment made to patients’ health plans

Defined as cost-based reimbursement (CBR) equal to 100% of Portway’s reasonable costs of providing services to Medicaid recipients

Potential providers in a plan’s network to the number of individuals in the area to be served by the plan

Providers in a plan’s network to the number of enrollees in the plan

Providers outside a plan’s network to the number of providers in the plan’s network

Support staff in a plan’s network to the number of medical practitioners in the plan’s network

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

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

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.

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.