← Back to exam page

AHM-530 – Network Management

Loading demo links...

Showing 10–12 of 15 questions

Question 10 (Volume A)

The Aegean Health Plan delegated its utilization management (UM) program to the Silhouette IPA. Silhouette, in turn, transferred authority for case management to Brandon Health Services. In this situation, Brandon is best described as the

Select an option, then click Submit answer.

  • ○

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

  • ○

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

  • ○

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

  • ○

    subdelegate, and Silhouette is ultimately responsible for Brandon’s performance
Question 11 (Volume A)

Federal laws—including the Ethics in Patient Referrals Act, the Health Maintenance Organization (HMO) Act of 1973, the Employee Retirement Income Security Act (ERISA), and the Federal Trade Commission Act—have impacted the ways that health plans conduct business. For instance, the Mosaic Health Plan must comply with the following federal laws in order to operate:

Regulation 1: Mosaic must establish a mandated grievance resolution mechanism, including a method for members to address grievances with network providers.

Regulation 2: Mosaic must not allow its providers to refer Medicare and Medicaid patients to entities in which they have a financial or ownership interest.

From the answer choices below, select the response that correctly identifies the federal legislation on which Regulation 1 and Regulation 2 are based.

Select an option, then click Submit answer.

  • ○

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

  • ○

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

  • ○

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

  • ○

    Regulation 1 - The Federal Trade Commission Act Regulation 2 - ERISA
Question 12 (Volume B)

The provider contract that Dr. Laura Cartier has with the Sailboat health plan includes a section known as the recitals. Dr. Cartier's contract includes the following statements:

Select an option, then click Submit answer.

  • ○

    A statement that identifies the purpose of the contract

    A, B, and C
  • ○

    A statement that defines in legal terms the parties to the contract

    A and B only
  • ○

    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
  • ○

    B and C only