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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

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Question 1

Health plans are required to follow several regulations and guidelines regarding the access and adequacy of their provider networks. The Federal Employee Health Benefits Program (FEHBP) regulations, for example, require that health plans

Options:

A.

Allow members direct access to OB/GYN services

B.

Allow members direct access to prescription drug services

C.

Provide access to Title X family-planning clinics

D.

Provide average office waiting times of no more than 30 minutes for appointments with plan providers

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Question 2

Martin Breslin, age 72 and permanently disabled, is classified as dually-eligible. This information indicates that Mr. Breslin qualifies for coverage by both

Options:

A.

Medicare and private indemnity insurance, and Medicare provides primary coverage

B.

Medicare and Medicaid, and Medicare provides primary coverage

C.

Medicaid and private indemnity insurance, and Medicaid provides primary coverage

D.

Medicare and Medicaid, and Medicaid provides primary coverage

Question 3

Dr. Michelle Kubiak has contracted with the Gem Health Plan, a Medicare+Choice health plan, to provide medical services to Gem's enrollees. Gem pays Dr. Kubiak $40 per enrollee per month for providing primary care. Gem also pays her an additional $10 per enrollee per month if the cost of referral services falls below a targeted level. This information indicates that, according to the substantial financial risk formula, Dr. Kubiak's referral risk under this contract is equal to:

Options:

A.

20%, and therefore this arrangement puts her at substantial financial risk

B.

20%, and therefore this arrangement does not put her at substantial financial risk

C.

25%, and therefore this arrangement puts her at substantial financial risk

D.

25%, and therefore this arrangement does not put her at substantial financial risk

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