AHM-530 Free Practice Test

- (Topic 1)
From the following answer choices, choose the term that best matches the description.
An integrated delivery system (IDS), which controls most providers in a particular specialty, agrees to provide that specialty service to a health plan only on thecondition that the health planagree to contract with the IDS for other services.

1. A. Group boycott
2. B. Horizontal division of territories
3. C. Tying arrangements
4. D. Concerted refusal to admit

Correct Answer: C

- (Topic 2)
The Elizabethan Health Plan uses a direct referral program, which means that

1. A. PCPs in Elizabethan’s network can make most referrals without obtaining prior authorization from Elizabethan
2. B. PCPs in Elizabethan’s network must always refer plan members to other specialists within the network
3. C. Elizabethan’s plan members can bypass the PCP and obtain medical services from a specialist without a referral
4. D. Elizabethan’s plan members must obtain referrals directly from Elizabethan

Correct Answer: A

- (Topic 1)
The Avignon Company discontinued its contract with a traditional indemnity insurer and contracted exclusively with the Minaret Health Plan to provide the sole healthcare plan to Avignon’s employees. By agreeing to an exclusive contract with Minaret, Avignon has entered into a type of healthcare contract known as

1. A. a carrier guarantee arrangement
2. B. open access
3. C. total replacement coverage
4. D. selective contract coverage

Correct Answer: C

- (Topic 2)
As part of the credentialing process, many health plans use the National Practitioner Data Bank (NPDB) to learn information about prospective members of a provider network. One true statement about the NPDB is that:

1. A. It is maintained by the individual states
2. B. It primarily includes information about any censures, reprimands, or admonishments against any physicians who are licensed to practice medicine in the United States
3. C. The information in the NPDB is available to the general public
4. D. It was established to identify and discipline medical practitioners who act unprofessionally

Correct Answer: D

- (Topic 2)
One true statement about the Employee Retirement Income Security Act of 1974 (ERISA) is that:

1. A. ERISA applies to all issuers of health insurance products, such as HMOs
2. B. pension plans and employee welfare plans are exempt from any regulation under ERISA
3. C. ERISA requires self-funded plans to comply with all state mandates affecting health insurance companies and health plans
4. D. the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans

Correct Answer: D