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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

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

Options:

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.

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Question 2

Although a health plan is allowed to delegate many activities to outside sources, the National Committee for Quality Assurance (NCQA) has determined that some activities are not delegable.

These activities include

Options:

A.

evaluation of new medical technologies

B.

overseeing delegated medical records activities

C.

developing written statements of members’ rights and responsibilities

D.

all of the above

Question 3

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

Options:

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