Sure Pass Exam AHM-530 PDF

Network Management Questions and Answers

Question 9

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

Options:

Made for services rendered to specific patients

Made with matching state and federal funds

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

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

Question 10

One characteristic of the workers' compensation program is that:

Options:

workers' compensation coverage is available to all employees, regardless of their eligibility for health insurance coverage

indemnity benefits currently account for less than 10% of all workers' compensation benefits

workers' compensation programs in most states require eligible employees to obtain medical treatment only from members of a provider network

workers' compensation programs include deductibles and coinsurance requirements

Question 11

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

Options:

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

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

Both A and B

A only

B only

Neither A nor B

Question 12

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:

Options:

medical advisory committee

credentialing committee

utilization management committee

quality management committee

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Network Management Questions and Answers

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