AHIP AHM-530 - Network Management Exam

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Total 202 questions

Lakesha Frazier, a member of a health plan in a rural area, had been experiencing heart palpitations and shortness of breath. Ms. Fraziers primary care provider (PCP) referred her to a local hospital for an electrocardiogram. The results of the electrocardiogram were transmitted for diagnosis via high-speed data transmission to a heart specialist in a city 500 miles away. This information indicates that the results of Ms. Fraziers electrocardiogram were transmitted using a communications system known as

  • A. Anarrow network
  • B. An integrated healthcare delivery system
  • C. Telemedicine
  • D. Customized networking


Answer : C

The Octagon Health Plan includes a typical indemnification clause in its provider contracts.
The purpose of this clause is to require Octagons network providers to

  • A. Agree not to sue or file claims against an Octagon plan member for covered services
  • B. Reimburse Octagon for costs, expenses, and liabilities incurred by the health plan as a result of a providers actions
  • C. Maintain the confidentiality of the health plan’s proprietary information
  • D. Agree to accept Octagons payment as payment in full and not to bill members for anything other than contracted copayments, coinsurance, or deductibles


Answer : B

From the following answer choices, choose the type of clause or provision described in this situation.
The Idlewilde Health Plan includes in its provider contracts a clause or provision that allows the terms of the contract to renew unchanged each year.

  • A. Cure provision
  • B. Hold-harmless provision
  • C. Evergreen clause
  • D. Exculpation clause


Answer : C

The Justice Health Plan is eligible to submit reportable actions against medical practitioners to the National Practitioner Data Bank (NPDB). Justice is considering whether it should report the following actions to the NPDB:
Action 1A medical malpractice insurer made a malpractice payment on behalf of a dentist in Justices network for a complaint that was settled out of court.
Action 2Justice reprimanded a PCP in its network for failing to follow the health plans referral procedures.
Action 3Justice suspended a physicians clinical privileges throughout the Justice network because the physicians conduct adversely affected the welfare of a patient.
Action 4Justice censured a physician for advertising practices that were not aligned with
Justices marketing philosophy.
Of these actions, the ones that Justice most likely must report to the NPDB include Actions

  • A. 1, 2, and 3 only
  • B. 1 and 3 only
  • C. 2 and 4 only
  • D. 3 and 4 only


Answer : B

With respect to hiring practices, one step that a health plan most likely can take to avoid violating the terms of the Americans with Disabilities Act (ADA) is to

  • A. Require a medical examination prior to accepting an application for employment
  • B. Include in the employment application questions pertaining to health status
  • C. Make a conditional offer of employment, and then require the candidate to have an examination prior to granting specific staff privileges
  • D. Require applicants to answer questions pertaining to the use of drugs and alcohol


Answer : C

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Total 202 questions