CompTIA
Checkpoint
ISC
HP
Dell
EC-Council
EXIN
Fortinet
ITIL®
Juniper
PMI
Microsoft
VMware
Avaya
Google
Salesforce
Amazon
Palo Alto Networks
Certiport
ISC2
All Vendors
  2. Home
  3. Exams
  4. AHIP
  5. AHM-520

Free AHM-520 Exam Braindumps (page: 8)

Page 7 of 55
PDF with 215 Questions

The provider contract that Dr. Timothy Meyer, a pediatrician, has with the Cardigan health plan states that Cardigan will compensate him under a capitation arrangement. However, the contract also includes a typical low enrollment guarantee provision. Statements that can correctly be made about this arrangement include that the low enrollment guarantee provision most likely:

A Causes Dr. Meyer's capitation contract with Cardigan to transfer more risk to him than the contract otherwise would transfer
B) Specifies that Cardigan will pay Dr. Meyer under an arrangement other than capitation until a specified number of children covered by the plan use him as their PCP

  1. Both A and B
  2. A only
  3. B only
  4. Neither A nor B

Answer(s): C



One true statement about a type of capitation known as a percent-of-premium arrangement is that this arrangement

  1. Is the most common type of capitation
  2. Is less attractive to providers when the arrangement sets provisions to limit risk
  3. Sets provider reimbursement at a specific dollar amount per plan member
  4. Transfers some of the risk associated with underwriting and rating from a health plan to a provider

Answer(s): D



The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for

  1. All of the diagnostic tests that he ordered on Ms. Pfeiffer
  2. His visits to Ms. Pfeiffer while she was hospitalized
  3. The cost of the services that the specialist performed for Ms. Pfeiffer
  4. All of the above

Answer(s): B



The following statements illustrate common forms of capitation:
1. The Antler Health Plan pays the Epsilon Group, an integrated delivery system (IDS), a capitated amount to provide substantially all of the inpatient and outpatient services that Antler offers. Under this arrangement, Epsilon accepts much of the risk that utilization rates will be higher than expected. Antler retains responsibility for the plan's marketing, enrollment, premium billing, actuarial, underwriting, and member services functions.
2. The Bengal Health Plan pays an independent physician association (IPA) a capitated amount to provide both primary and specialty care to Bengal's plan members. The payments cover all physician services and associated diagnostic tests and laboratory work. The physicians in the IPA determine as a group how the individual physicians will be paid for their services.

From the following answer choices, select the response that best indicates the form of capitation used by Antler and Bengal.

  1. Antler = subcapitation
    Bengal = full-risk capitation
  2. Antler = subcapitation
    Bengal = full professional capitation
  3. Antler = global capitation
    Bengal = subcapitation
  4. Antler = global capitation
    Bengal = full professional capitation

Answer(s): D






Post your Comments and Discuss AHIP AHM-520 exam with other Community members:

AHM-520 Discussions & Posts