AHM-530 Free Practice Test

- (Topic 1)
If a third party is responsible for injuries to a plan member of the Hope Health Plan, then Hope has a contractual right to file a claim for the resulting healthcare costs against the third party. This contractual right to recovery from the third party is known as

1. A. Subrogation
2. B. Partial capitation
3. C. Coordination of benefits
4. D. Aremedy provision

Correct Answer: A

- (Topic 2)
The Blanchette Health Plan uses a method of claims submission that allows its providers to submit claims directly to Blanchette through a computer application-to-application exchange of claims using a standard data format. This information indicates that Blanchette allows its providers to submit claims using technology known as

1. A. Telemedicine
2. B. An electronic referral system
3. C. Electronic data interchange
4. D. Encounter reporting

Correct Answer: C

- (Topic 2)
One characteristic of the workers' compensation program is that:

1. A. workers' compensation coverage is available to all employees, regardless of their eligibility for health insurance coverage
2. B. indemnity benefits currently account for less than 10% of all workers' compensation benefits
3. C. workers' compensation programs in most states require eligible employees to obtain medical treatment only from members of a provider network
4. D. workers' compensation programs include deductibles and coinsurance requirements

Correct Answer: A

- (Topic 2)
The following statements are about network management for behavioral healthcare (BH). Three of these statements are true and one statement is false. Select the answer choice containing the FALSE statement.

1. A. Two measures of BH quality are patient satisfaction and clinical outcomes assessments.
2. B. For a health plan, one argument in favor of contracting with a managed behavioral healthcare organization (MBHO) is that the health plan's members can gain faster access to BH care.
3. C. In their contracts with health plans, managed behavioral healthcare organizations (MBHOs) usually receive delegated authority for network development and management.
4. D. Health plans generally compensate managed behavioral healthcare organizations (MBHOs) on an FFS basis.

Correct Answer: D

- (Topic 1)
The following statements are about factors that health plans should consider as they develop provider networks in rural and urban markets. Three of the statements are true, and one of the statements is false. Select the answer choice that contains the FALSE statement.

1. A. Compared to providers in urban areas, providers in rural areas are less likely to offer discounts to health plans in exchange for directed patient volume.
2. B. In urban areas, limiting the number of specialists on a panel usually affects the network’s market appeal more than does limiting the number of primary care physicians.
3. C. The greatest opportunity to create competition in rural areas is among the specialty providers in other nearby communities.
4. D. Typically, hospital contracting is easier in urban areas than in rural areas.

Correct Answer: B