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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

The Bruin Health Plan is a Social Health Maintenance Organization (SHMO). As an SHMO, Bruin:

Options:

A.

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

B.

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

C.

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

D.

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

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Question 2

The Portway Hospital is qualified to receive Medicaid subsidy payments as a disproportionate share hospital (DHS). The DHS payments that Portway receives are

Options:

A.

Made for services rendered to specific patients

B.

Made with matching state and federal funds

C.

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

D.

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

Question 3

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