AHIP AHM-530 - Network Management Exam
Page: 1 / 41
Total 202 questions
Question #1 (Topic: Topic 1)
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
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
Question #2 (Topic: Topic 1)
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
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
Question #3 (Topic: Topic 1)
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.
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
Question #4 (Topic: Topic 1)
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
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
Question #5 (Topic: Topic 1)
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
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
