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  • Exam Name: Network Management
  • Last Update: 09-Oct-2024
  • Questions and Answers: 202
  • Single Choice: 202 Q&A's

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AHM-530 Questions and Answers

Question # 1

Medicaid beneficiaries pose a challenge for health plans attempting to establish Medicaid provider networks. Compared to membership in commercial health plans, Medicaid enrollees typically

A.

Require access to greater numbers of obstetricians and pediatricians

B.

Have stronger relationships with primary care providers

C.

Are less reliant on emergency rooms as a source of first-line care

D.

Need fewer support and ancillary services

Question # 2

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:

A.

In order to supply a provider network to furnish healthcare to workers' compensation beneficiaries, a health plan typically uses the network that has already been created for the group health plan.

B.

Typically, case managers for workers' compensation programs are physical therapists.

C.

Most states prohibit the use of fee schedules in order to curb the rising workers' compensation healthcare costs.

D.

Networks serving workers' compensation patients typically include higher concentrations of specialists than do other provider networks.

Question # 3

The Ventnor Health Plan requires the physicians in its provider network to be board certified. Ventnor has received requests to become a part of the network from the following specialists:

Cheryl Stovall, who is currently in the process of completing a residency in her field of specialization.

Thomas Kalil, who has completed a residency in his field of specialization and has passed a qualifying examination in that field within two years of completing his residency.

Roger Todd, who has completed a residency in his field of specialization but has not passed a qualifying examination in that field.

Ventnor's requirement of board certification is met by:

A.

Cheryl Stovall, Thomas Kalil, and Roger Todd.

B.

Thomas Kalil and Roger Todd only.

C.

Thomas Kalil only.

D.

None of these individuals.

Question # 4

One true statement about the Medicaid program in the United States is that:

A.

The federal financial participation (FFP) in a state's Medicaid program ranges from 20% to 40% of the state's total Medicaid costs

B.

Medicaid regulations mandate specific minimum benefits, under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, for all Medicaid recipients younger than age 30

C.

The individual states have responsibility for administering the Medicaid program

D.

Non-disabled adults and children in low-income families account for the majority of direct Medicaid spending

Question # 5

Although ambulatory payment classifications (APCs) bear some resemblance to diagnosis-related groups (DRGs), there are significant differences between APCs and DRGs. One of these differences is that APCs:

A.

typically allow for the assignment of multiple classifications for an outpatient visit

B.

always apply to a patient's entire hospital stay

C.

typically serve as a payment system for inpatient services

D.

typically include reimbursements for professional fees

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