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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

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

One characteristic of the workers' compensation program is that:

Options:

A.

workers' compensation coverage is available to all employees, regardless of their eligibility for health insurance coverage

B.

indemnity benefits currently account for less than 10% of all workers' compensation benefits

C.

workers' compensation programs in most states require eligible employees to obtain medical treatment only from members of a provider network

D.

workers' compensation programs include deductibles and coinsurance requirements