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AHM-530 Exam Dumps : Network Management

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Question 1

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

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Question 2

Dr. Michelle Kubiak has contracted with the Gem Health Plan, a Medicare+Choice health plan, to provide medical services to Gem's enrollees. Gem pays Dr. Kubiak $40 per enrollee per month for providing primary care. Gem also pays her an additional $10 per enrollee per month if the cost of referral services falls below a targeted level. This information indicates that, according to the substantial financial risk formula, Dr. Kubiak's referral risk under this contract is equal to:

Options:

A.

20%, and therefore this arrangement puts her at substantial financial risk

B.

20%, and therefore this arrangement does not put her at substantial financial risk

C.

25%, and therefore this arrangement puts her at substantial financial risk

D.

25%, and therefore this arrangement does not put her at substantial financial risk

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

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