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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 Portway Hospital is qualified to receive Medicaid subsidy payments as a disproportionate share hospital (DHS). The DHS payments that Portway receives are

Options:

A.

Made for services rendered to specific patients

B.

Made with matching state and federal funds

C.

Included in the Medicaid capitation payment made to patients’ health plans

D.

Defined as cost-based reimbursement (CBR) equal to 100% of Portway’s reasonable costs of providing services to Medicaid recipients

Question 3

Dr. Sylvia Cimer and Dr. Andrew Donne are obstetrician/gynecologists who participate in the same provider network. Dr. Comer treats a large number of high-risk patients, whereas Dr. Donne’s patients are generally healthy and rarely present complications. As a result, Dr. Comer typically uses medical resources at a much higher rate than does Dr. Donne. In order to equitably compare Dr. Comer’s performance with Dr. Donne’s performance, the health plan modified its evaluation to account for differences in the providers’ patient populations and treatment protocols. The health plan modified Dr. Comer’s and Dr. Donne’s performance data by means of

Options:

A.

Acase mix/severity adjustment

B.

An external performance standard

C.

Structural measures

D.

Behavior modification