AHIP AHM-530 問題集

質問 1：
Dr. Ahmad Shah and Dr. Shantelle Owen provide primary care services to Medicare+Choice enrollees of health plans under the following physician incentive plans:
Dr. Shah receives $40 per enrollee per month for providing primary care and an additional $10 per enrollee per month if the cost of referral services falls below a specified level
Dr. Owen receives $30 per enrollee per month for providing primary care and an additional $15 per enrollee per month if the cost of referral services falls below a specified level
The use of a physician incentive plan creates substantial risk for
A. Neither Dr. Shah nor Dr. Owen
B. Both Dr. Shah and Dr. Owen
C. Dr. Shah only
D. Dr. Owen only
正解：D

質問 2：
Dr. Eve Barlow is a specialist in the Amity Health Plan's provider network. Dr. Barlow's provider contract with Amity contains a typical most-favored-nation arrangement. The purpose of this arrangement is to
A. Specify that the contract is to be governed by the laws of the state in which Amity has its headquarters
B. State that the contract creates an employment or agency relationship, rather than an independent contractor relationship, between Dr. Barlow and Amity
C. Require Dr. Barlow to charge Amity her lowest rate for a medical service she has provided to an Amity plan member, even if the rate is lower than the price negotiated in the contract
D. Require Dr. Barlow and Amity to use arbitration to resolve any disputes regarding the contract
正解：C

質問 3：
The Edgewood Health Plan uses a combination of structural, process, outcomes, and customer satisfaction measures to evaluate its network providers' performance. Edgewood would correctly use outcomes measures to evaluate a provider's
A. Compliance with specific regulatory or accrediting requirement
B. Appropriate use of specified procedures
C. Patient progress following treatment
D. Patient perceptions about how well the provider addresses medical problems
正解：C

質問 4：
One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement. However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method
A. applies to treatment received during an entire hospital stay
B. is typically used for outpatient care
C. is considered to be a retrospective payment system
D. assigns a single code for treatment
正解：B

質問 5：
The Gladspell HMO has contracted with the Ellysium Hospital to provide subacute care to its plan members. Gladspell pays Ellysium by using a per diem reimbursement method.
If the Ellysium subacute care unit is typical of most hospital-based subacute skilled nursing units, then this unit could be used for patients who no longer need to be in the hospital's acute care unit but who still require
A. Respiratory therapy
B. Daily medical care and monitoring
C. Regular rehabilitative therapy
D. All of the above
正解：D