AHM-530 Exam Dumps : Network Management

has a legal right to access a prospective provider’s confidential medical records at any time

must limit any evaluations of a prospective provider’s office to an assessment of quantitative factors, such as the number of double-booked appointments a physicianaccepts at the end of each day

is prohibited by law from conducting primary verification of such data as a prospective provider’s scope of medical malpractice insurance coverage and federal tax identification number

must complete the credentialing process before a provider signs the network contract or must include in the signed document a provision that the final contract is contingent upon the completion of the credentialing process

average cost of services delivered to all patients living in a specified geographic region

actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits

fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status

average fixed monthly fee paid by all Medicare enrollees in a specified geographic region

Must provide Medicare participants with standard HMO benefits, as well as with limited long-term care benefits

Does not need as great a variety of provider types or as complex a reimbursement method as does a traditional HMO

Receives a payment that is based on reasonable costs and reasonable charges

Most likely provides fewer supportive services than does a traditional HMO, because one of Bruin's goals is to minimize the use of community-based care