Online Access Free AHM-530 Exam Questions

One true statement about the Employee Retirement Income Security Act of 1974 (ERISA) is that:

• A.pension plans and employee welfare plans are exempt from any regulation under ERISA
• B.the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans
• C.ERISA requires self-funded plans to comply with all state mandates affecting health insurance companies and health plans
• D.ERISA applies to all issuers of health insurance products, such as HMOs

One type of fee schedule payment system assigns a weighted unit value for each medical procedure or service based on the cost and intensity of that service. Under this system, the unit values for procedural services are generally higher than the unit values for cognitive services. This system is known as a

• A.Resource-based relative value scale (RBRVS) system
• B.Wrap-around payment system
• C.Capped fee system
• D.Relative value scale (RVS) payment system

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:

• A.Typically, case managers for workers' compensation programs are physical therapists.
• B.Networks serving workers' compensation patients typically include higher concentrations of specialists than do other provider networks.
• C.Most states prohibit the use of fee schedules in order to curb the rising workers' compensation healthcare costs.
• D.In order to supply a provider network to furnish healthcare to workers' compensation beneficiaries, a health plan typically uses the network that has already been created for the group health plan.

As part of the credentialing process, many health plans use the National Practitioner Data Bank (NPDB) to learn information about prospective members of a provider network. One true statement about the NPDB is that:

• A.The information in the NPDB is available to the general public
• B.It is maintained by the individual states
• C.It was established to identify and discipline medical practitioners who act unprofessionally
• D.It primarily includes information about any censures, reprimands, or admonishments against any physicians who are licensed to practice medicine in the United States

The sizes of the businesses in a market affect the types of health programs that are likely to be purchased. Compared to smaller employers (those with fewer than 100 employees), larger employers (those with more than 1,000 employees) are

• A.less likely to contract with health plans
• B.more likely to contract with indemnity health plans
• C.more likely to offer their employees a choice in health plans
• D.less likely to require a wide variety of benefits