Free AHM-530 – Network Management Practice Test Question

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  Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists
  

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  Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient
  

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  Tend to increase the number of providers who are considered to be outliers
  

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  Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care
  

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  Slower access to BH care for plan members
  

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  Increased collaboration between BH providers and PCPs
  

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  Fewer specialized BH services for plan members
  

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  Decreased continuity of BH care for plan members
  

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  A narrow network
  

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  An integrated healthcare delivery system
  

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  Telemedicine
  

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  Customized networking
  

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  Consistent with the symptoms of diagnosis
  

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  Furnished in the least intensive type of medical care setting required by the member’s condition
  

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  In compliance with the standards of good medical practice
  

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  All of the above
  

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  Typically, a health plan should attempt to control utilization of SCPs before attempting to place these providers under a capitation arrangement.
  
  Both A and B
  

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  Forms of specialty physician reimbursement used by health plans include a retainer and a bundled case rate.
  
  
  A only
  

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  B only
  

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  Neither A nor B
  

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  that the value of each referral point for the first quarter was $120
  

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  that the value of Foxfire's contact capitation fund for dermatologists for the first quarter was $20,000
  

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  that the payment that Foxfire owed Dr. Rashad for the first quarter was $6,120
  

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  all of the above
  

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  When pharmacy benefits management is incorporated into an health plan’s operations as a unified benefit, the health plan establishes pharmacy networks, but a pharmacy benefits management (PBM) company manages their operations.
  

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  Under a unified pharmacy benefit, an health plan cannot use mail-order services to provide drugs to its members.
  

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  Compared to programs that do not manage pharmacy benefits in-house, unified pharmacy benefits programs typically give health plans more control over patient access to prescription drugs.
  

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  Compared to programs that do not manage pharmacy benefits in-house, unified pharmacy benefits programs make drug therapy interventions for plan members more difficult.
  

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  Column most likely contracted with the legal group representing the FPP rather than with the individual physicians within the FPP.
  
  Both A and B
  

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  Column most likely will provide only highly specialized care to Argyle's plan members.
  
  
  A only
  

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  B only
  

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  Neither A nor B
  

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  Provides the lowest level of cost for the health plan
  

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  Most closely represents what pharmacies are actually charged for prescription drugs
  

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  Offers the best control over multiple-source pharmaceutical products
  

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  Is the least expensive pricing system for the health plan to implement
  

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  delegator, and Aegean is ultimately responsible for Brandon’s performance
  

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  delegator, and Silhouette is ultimately responsible for Brandon’s performance
  

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  subdelegate, and Aegean is ultimately responsible for Brandon’s performance
  

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  subdelegate, and Silhouette is ultimately responsible for Brandon’s performance
  

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  Regulation 1 - The Ethics in Patient Referrals Act Regulation 2 - The HMO Act of 1973
  

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  Regulation 1 - The HMO Act of 1973 Regulation 2 - The Ethics in Patient Referrals Act
  

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  Regulation 1 - ERISA Regulation 2 - The Federal Trade Commission Act
  

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  Regulation 1 - The Federal Trade Commission Act Regulation 2 - ERISA
  

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  A statement that identifies the purpose of the contract
  
  A, B, and C
  

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  A statement that defines in legal terms the parties to the contract
  
  A and B only
  

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  A statement that identifies the Sailboat products to be covered by the contract
  Of these statements, the ones that are likely to be included in the recitals section of Dr. Cartier's contract are statements:
  
  
  A and C only
  

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  B and C only
  

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  Allows Trilogy to deny benefits for an employee's on-the-job injury or illness, but only if Trilogy is not at fault for the injury or illness.
  

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  Allows Trilogy to place limits on the amount of coverage payable for a given claim under the workers' compensation program.
  

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  Requires the employees to accept workers' compensation as their only compensation in cases of work-related injury or illness.
  

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  Provides the employees with 24-hour coverage.
  

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  A case mix/severity adjustment
  

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  An external performance standard
  

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  Structural measures
  

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  Behavior modification
  

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  Potential providers in a plan’s network to the number of individuals in the area to be served by the plan
  

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  Providers in a plan’s network to the number of enrollees in the plan
  

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  Providers outside a plan’s network to the number of providers in the plan’s network
  

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  Support staff in a plan’s network to the number of medical practitioners in the plan’s network