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：
The following situations illustrate violations of federal antitrust laws:
Situation A Two HMOs split a large employer group by agreeing to let one HMO market to some company employees and to let the second HMO market to different company employees.
Situation B Members of a physician-hospital organization (PHO) that has significant market share jointly agreed to exclude a physician from joining the PHO solely because that physician has admitting privileges at a competing hospital.
From the following answer choices, select the response that best identifies the types of violations illustrated by these situations:
A. Situation A: exclusive arrangement; Situation B: tying arrangement
B. Situation A: exclusive arrangement; Situation B: group boycott
C. Situation A: horizontal division of territories; Situation B: group boycott
D. Situation A: horizontal division of territories; Situation B: exclusive arrangement
正解：C

質問 2：
From the following answer choices, choose the type of clause or provision described in this situation.
The Aviary Health Plan includes in its provider contracts a clause or provision that places the ultimate responsibility for an Aviary plan member's medical care on the provider.
A. Cure provision
B. Evergreen clause
C. Exculpation clause
D. Hold-harmless provision
正解：C

質問 3：
Prior to the enactment of the Balanced Budget Act (BBA) of 1997, payment for Medicare-covered primary and acute care services was based on the adjusted average per capita cost (AAPCC). The AAPCC is defined as the
A. average fixed monthly fee paid by all Medicare enrollees in a specified geographic region
B. average cost of services delivered to all patients living in a specified geographic region
C. fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status
D. actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits
正解：C

質問 4：
After HIPAA was enacted, Congress amended the law to include the Mental Health Parity Act (MHPA) of 1996, a federal requirement relating to mental health benefits. One true statement about the MHPA is that it
A. prohibits health plans that offer mental health benefits from applying more restrictive limits on coverage for mental illness than on coverage for physical illness
B. requires all health plans to provide coverage for mental health services
C. allows health plans to require patients receiving mental health services to pay higher copayments than patients seeking treatment for physical illnesses
D. requires health plans to carve out mental/behavioral healthcare from other services provided by the plans
正解：A

質問 5：
The BBA of 1997 specifies the ways in which a Medicare+Choice plan can establish and use provider networks. A Medicare+Choice plan that operates as a private fee for service (PFFS) plan is allowed to
A. shift all risk for Medicare-covered services to network providers
B. refuse payment to non-network providers who submit claims for Medicare-covered expenses
C. require providers to accept as payment in full an amount no greater than 115% of the Medicare payment rate
D. limit the size of its network to the number of providers necessary to meet the needs of its enrollees
正解：C

質問 6：
The following statements are about managed dental care. Three of these statements are true, and one is false. Select the answer choice containing the FALSE statement.
A. Currently, there are no nationally recognized standards for quality in managed dental care.
B. Managed dental care is federally regulated.
C. Processes for selecting dental care providers vary greatly according to state regulations on managed dental care networks and the health plan's standards.
D. Dental HMOs typically need very few healthcare facilities because almost all dental services are delivered in an ambulatory care setting.
正解：B

質問 7：
If a member of the Green Health Plan reasonably believes that a provider in Green's provider network was acting as Green's employee or agent while providing negligent care, then the member may have cause to bring action against the health plan. This legal concept is known as vicarious liability. Steps that Green can take to reduce its exposure to vicarious liability claims include:
A. Implementing risk management and quality assurance programs for its provider network.
B. Including in its provider agreements and marketing and membership literature a statement that members of the Green provider network are not independent contractors.
C. Placing restrictions on provider-member communication involving treatment decisions.
D. All of the above.
正解：A

質問 8：
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
A. Coordination of benefits
B. Subrogation
C. Partial capitation
D. Aremedy provision
正解：B