最新なAHIP AHM-530問題集（202題）、真実試験の問題を全部にカバー！

質問 1：
Member satisfaction surveys help an health plan determine whether its providers are consistently delivering services to plan members in a manner that lives up to member expectations. Member satisfaction surveys allow the health plan to gather information about
A. All of the above
B. The reactions of specific subsets of the health plan's membership
C. Members' positive and negative experience with the plan's services
D. Amember's reaction to services received during a specific encounter
正解：A

質問 2：
The Sweeney Health Plan uses the discounted fee-for-service (DFFS) method to compensate some of its providers. Under this method of compensation, Sweeney calculates payments based on
A. The Medicare fee schedules used by other health plans, adjusted by region
B. Whichever amount is lower, the billed charge or the DFFS amount
C. The standard fees of indemnity health insurance plans, adjusted by region
D. Whichever amount is higher, the billed charge or the DFFS amount
正解：B

質問 3：
One important aspect of network management is profiling, or provider profiling. Profiling is most often used to
A. verify a prospective provider's professional licenses, certifications, and training
B. measure the overall performance of providers who are already participants in the network
C. familiarize a provider with a plan's procedures for authorizations and referrals
D. assess a provider's overall satisfaction with a plan's service protocols and other operational areas
正解：B

質問 4：
If the Oconee Health Plan reimburses its specialty care physicians (SCPs) under a typical retainer method, then Oconee pays SCPs
A. Aseparate amount for each service provided, and the payment amount is based solely on a resource-based relative value scale (RBRVS)
B. Aset amount of cash equivalent to a defined time period's expected reimbursable charges
C. Aspecified fee that remains the same regardless of how much or how little time or effort is spent on the medical service performed
D. Aset amount each month, and Oconee reconciles its payment at periodic intervals on the basis of actual utilization
正解：D

質問 5：
Although a health plan is allowed to delegate many activities to outside sources, the National Committee for Quality Assurance (NCQA) has determined that some activities are not delegable.
These activities include
A. all of the above
B. evaluation of new medical technologies
C. developing written statements of members' rights and responsibilities
D. overseeing delegated medical records activities
正解：A

質問 6：
The Adobe Health Plan complies with all of the provisions of the Newborns' and Mothers' Health Protection Act (NMHPA) of 1996. Kristen Netzger, an Adobe enrollee, was hospitalized for a cesarean delivery. Amy Davis, also an Adobe enrollee, was hospitalized for a normal delivery. From the following answer choices, select the response that indicates the minimum length of time for which Adobe, under NMHPA, most likely must provide benefits for the hospitalizations of Ms. Netzger and Ms. Davis.
A. Ms. Netzger = 72 hours Ms. Davis = 72 hours
B. Ms. Netzger = 96 hours Ms. Davis = 72 hours
C. Ms. Netzger = 96 hours Ms. Davis = 48 hours
D. Ms. Netzger = 48 hours Ms. Davis = 48 hours
正解：C

質問 7：
The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 allowed competitive medical plans (CMPs) to participate in the Medicare program on a risk basis. Under the terms of Medicare risk contracts, CMPs were required to deliver all medically necessary Medicare-covered services in return for a
A. fixed monthly capitation payment from CMS
B. fee-for-service payment from the appropriate state Medicare agency
C. mandatory premium paid by plan enrollees
D. fee equal to twice the actuarial value of the Medicare deductible and coinsurance paid by plan enrollees
正解：A

質問 8：
As an authorized Medicare+Choice plan, the Brightwell HMO must satisfy CMS requirements regulating access to covered services. In order to ensure that its network provides adequate access, Brightwell must
A. Define its service area according to community patterns of care
B. Base a provider's participation in the network, reimbursement, and indemnification levels on the provider's license or certification
C. Allow enrollees to determine whether they will receive primary care from a physician, nurse practitioner, or other qualified network provider
D. Require enrollees to obtain prior authorization for all emergency or urgently needed services
正解：A

質問 9：
The Enterprise Health Plan has indicated an interest in delegating its medical records review activities to the Teal Group and has forwarded a typical letter of intent to Teal. One true statement about this letter of intent is that it:
A. Serves as a delegation agreement between Enterprise and Teal
B. Outlines the delegation oversight process
C. Cannot include a confidentiality clause
D. Is a contract that creates a legally binding relationship between Enterprise and Teal
正解：B