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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

Prior to the enactment of the Balanced Budget Act (BBA) of 1997, payment for Medicare-covered primary and acute care services was based on the adjusted average per capita cost (AAPCC). The AAPCC is defined as the

Options:

A.

average cost of services delivered to all patients living in a specified geographic region

B.

actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits

C.

fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status

D.

average fixed monthly fee paid by all Medicare enrollees in a specified geographic region

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Question 2

The following statement(s) can correctly be made about the Balanced Budget Act (BBA) of 1997:

Options:

A.

The BBA requires Medicare+Choice organizations to be licensed as non-risk-bearing entities under federal law.

B.

The Centers for Medicaid and Medicare Services (CMS) is responsible for implementing the BBA.

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Question 3

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.

In most states, a health plan can be held responsible for a provider’s negligent malpractice. This legal concept is known as (vicarious liability / risk sharing). One step that health plans can take to reduce their exposure to malpractice lawsuits is to state in health plan-provider agreements, marketing collateral, and membership literature that the providers are (employees of the health plan / independent contractors).

Options:

A.

Vicarious liability / employees of the health plan

B.

Vicarious liability / independent contractors

C.

Risk sharing / employees of the health plan

D.

Risk sharing / independent contractors