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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 Medicaid health plan entities. Select the answer choice containing the correct statement:

Options:

A.

To keep Medicaid enrollment costs as low as possible, states typically prohibit the use of third-party entities known as enrollment brokers to handle the recruitment and enrollment of Medicaid recipients in health plan plans

B.

Primary care case managers (PCCMs) are individuals who contract with a state's Medicaid agency to provide primary care services mainly to urban areas.

C.

Typically, Medicaid beneficiaries must be given a choice between at least two health plan entities.

D.

Medicaid health plan entities are responsible for providing primary coverage for all dually-eligible beneficiaries.

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Question 2

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.

In most states, a health plan can be held responsible for a provider’s negligent malpractice. This legal concept is known as (vicarious liability / risk sharing). One step that health plans can take to reduce their exposure to malpractice lawsuits is to state in health plan-provider agreements, marketing collateral, and membership literature that the providers are (employees of the health plan / independent contractors).

Options:

A.

Vicarious liability / employees of the health plan

B.

Vicarious liability / independent contractors

C.

Risk sharing / employees of the health plan

D.

Risk sharing / independent contractors

Question 3

Martin Breslin, age 72 and permanently disabled, is classified as dually-eligible. This information indicates that Mr. Breslin qualifies for coverage by both

Options:

A.

Medicare and private indemnity insurance, and Medicare provides primary coverage

B.

Medicare and Medicaid, and Medicare provides primary coverage

C.

Medicaid and private indemnity insurance, and Medicaid provides primary coverage

D.

Medicare and Medicaid, and Medicaid provides primary coverage