AHIP AHM-530 Exam Questions - Real Practice Questions for Guaranteed Success

Question 1

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:

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

Balways apply to a patient's entire hospital stay

Ctypically serve as a payment system for inpatient services

Dtypically include reimbursements for professional fees

Correct : A

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

Balways apply to a patient's entire hospital stay

Ctypically serve as a payment system for inpatient services

Dtypically include reimbursements for professional fees

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Question 3

The Pine Health Plan has incorporated pharmacy benefits management into its operations to form a unified benefit. Potential advantages that Pine can receive from this action include:

Athe fact that unified benefits improve the quality of patient care and the value of pharmacy services to Pine's plan members

Bthe fact that control over the formulary and network contracting can give Pine control over patient access to prescription drugs and to pharmacies

Cthe fact that managing pharmacy benefits in-house gives Pine a better chance to meet customer needs by integrating pharmacy services into the plan's total benefits package

Dall of the above

Correct : D

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Athe fact that unified benefits improve the quality of patient care and the value of pharmacy services to Pine's plan members

Bthe fact that control over the formulary and network contracting can give Pine control over patient access to prescription drugs and to pharmacies

Cthe fact that managing pharmacy benefits in-house gives Pine a better chance to meet customer needs by integrating pharmacy services into the plan's total benefits package

Dall of the above

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Question 4

Reimbursement for prescription drugs and services in a third-party prescription drug plan typically follows one of two approaches: a reimbursement approach or a service approach. One true statement about these approaches is that:

APayments under the reimbursement method typically are not subject to any copayment or deductible requirements

BPayments under the reimbursement approach are typically based on a structured reimbursement schedule rather than on usual, customary, and reasonable (UCR) charges

CMost major medical plans follow a service approach

DMost current health plan prescription drug plans are service plans

Correct : D

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APayments under the reimbursement method typically are not subject to any copayment or deductible requirements

BPayments under the reimbursement approach are typically based on a structured reimbursement schedule rather than on usual, customary, and reasonable (UCR) charges

CMost major medical plans follow a service approach

DMost current health plan prescription drug plans are service plans

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Question 5

The Walnut Health Plan provides a number of specialty services for its members. Walnut offers coverage of alternative healthcare, including coverage of treatment methods such as homeopathy and naturopathy. Walnut also offers home healthcare services, and it contracts with home healthcare providers on a non-risk basis to the health plan. The following statements are about the specialty services offered by Walnut. Select the answer choice containing the correct statement:

AHomeopathy treats diseases by using small doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated.

BNaturopathy is an approach to healthcare that uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate.

CUnder a non-risk contract, Walnut most likely transfers the responsibility for arranging home healthcare to the home healthcare provider organizations.

DFederal law allows Walnut to contract with a home healthcare provider organization only if the provider organization has received accreditation by the Utilization Review Accreditation Commission (URAC).

Correct : A

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AHomeopathy treats diseases by using small doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated.

BNaturopathy is an approach to healthcare that uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate.

CUnder a non-risk contract, Walnut most likely transfers the responsibility for arranging home healthcare to the home healthcare provider organizations.

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Master AHIP AHM-530 Exam with Reliable Practice Questions

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