AHIP AHM-530 Dumps PDF Free Download - Page: 8

QUESTION: 36

In contracting with providers, a health plan can use a closed panel or open panel approach. One statement that can correctly be made about an open panel health plan is that the participating providers

must be employees of the health plan, rather than independent contractors
are prohibited from seeing patients who are members of other health plans
typically operate out of their own offices
operate according to their own standards of care, rather than standards of care established by the health plan

Answer(s): C

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QUESTION: 37

In open panel contracting, there are several types of delivery systems. One such delivery system is the faculty practice plan (FPP). One likely result that a health plan will experience by contracting with an FPP is that the health plan will

be able to select most of the physicians in the FPP
achieve the highest level of cost effectiveness possible
experience limited control over utilization
achieve the most effective case management possible

Answer(s): C

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QUESTION: 38

The following statement(s) can correctly be made about hospitalists.

1. The hospitalist's main function is to coordinate diagnostic and treatment activities to ensure that the patient receives appropriate care while in the hospital.
2. The hospitalist's role clearly supports the health plan concept of disease management.

Both 1 and 2
1 only
2 only
Neither 1 nor 2

Answer(s): B

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QUESTION: 39

Salvatore Arris is a member of the Crescent Health Plan, which provides its members with a full range of medical services through its provider network. After suffering from debilitating headaches for several days, Mr. Arris made an appointment to see Neal Prater, a physician's assistant in the Crescent network who provides primary care under the supervision of physician Dr. Anne Hunt. Mr. Prater referred Mr. Arris to Dr. Ginger Chen, an ophthalmologist, who determined that Mr. Arris' symptoms were indicative of migraine headaches. Dr. Chen prescribed medicine for Mr. Arris, and Mr. Arris had the prescription filled at a pharmacy with which Crescent has contracted. The pharmacist, Steven Tucker, advised Mr. Arris to take the medicine with food or milk. In this situation, the person who functioned as an ancillary service provider is

Mr. Prater
Dr. Hunt
Dr. Chen
Mr. Tucker

Answer(s): D

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QUESTION: 40

Open panel health plans can contract with individual providers or with various provider groups when developing their networks. The following statements are about factors that an open panel health plan might consider in contracting with different types of provider organizations. Select the answer choice that contains the correct statement.

One limitation of contracting with multispecialty groups is that a health plan obtains only specialty consultants, but not PCPs.
One benefit to a health plan in contracting with an integrated delivery system (IDS) is the ability to have a network in rapid order and to enter into a new market or one that is already competitive.
A health plan that contracts with an individual practice association (IPA) has a greater ability to select and deselect individual physicians than when contracting directly with the providers.
A health plan that contracts with an IDS is able to eliminate the antitrust risk that exists when contracting with an IPA.

Answer(s): B

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QUESTION: 40