AHM-530 試験問題を無料オンラインアクセス

The Medea Clinic is a network provider for Delphic Healthcare. Delphic transferred the contract it held with Medea to the Elixir HMO, an entity that was not party to the original contract. The process by which Delphic transferred the contract it held with Medea to Elixir is known as

• A.An assignment
• B.Most-favored- nation arrangement
• C.Aconsideration
• D.Alimit on action

One true statement about the compensation arrangement known as the case rate system is that, under this system,

• A.Providers stand to gain or lose based on the number and types of treatments used for each case
• B.Payors have the opportunity to benefit from the provider's cost savings
• C.Providers have no incentives to take an active role in managing cost and utilization
• D.Payors cannot adjust standard case rates to reflect the severity of the patient's condition or complications that arise from multiple medical problems

Some jurisdictions have enacted corporate practice of medicine laws. One effect that corporate practice of medicine laws have had on HMO provider networks is that these laws typically

• A.require incorporated HMOs to practice medicine through licensed employees
• B.require HMOs to form exclusive contracts with physician groups who agree to dedicate all or most of their practices to HMO patients in return for a set payment or revenue-sharing
• C.encourage incorporated HMOs to obtain profits from their provisions of physician professional services
• D.restrict the ability of staff model HMOs to hire physicians directly, unless the physicians own the HMO

The Aztec Health Plan has a variety of organizational committees related to quality and utilization management. These committees include the medical advisory committee, the credentialing committee, the utilization management committee, and the quality management committee. Of these committees, the one that most likely is responsible for providing oversight of Aztec's inpatient concurrent review process is the:

• A.medical advisory committee
• B.utilization management committee
• C.credentialing committee
• D.quality management committee

Some states have enacted any willing provider laws. From the perspective of the health plan industry, one drawback of any willing provider laws is that they often result in a reduction of a plan's

• A.Premium rates
• B.Number of primary care providers (PCPs)
• C.Number of specialists and ancillary providers
• D.Ability to monitor utilization