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Free AHM-530 Exam Braindumps
Network Management Questions 71–75 (page: 16)

Updated On: 9-Feb-2026
Page 16 of 42
PDF with 202 Questions

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

  1. The standard fees of indemnity health insurance plans, adjusted by region
  2. The Medicare fee schedules used by other health plans, adjusted by region
  3. Whichever amount is higher, the billed charge or the DFFS amount
  4. Whichever amount is lower, the billed charge or the DFFS amount

Answer(s): D



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

  1. Wrap-around payment system
  2. Relative value scale (RVS) payment system
  3. Resource-based relative value scale (RBRVS) system
  4. Capped fee system

Answer(s): B



One true statement about the compensation arrangement known as the case rate system is that, under this system,

  1. Providers stand to gain or lose based on the number and types of treatments used for each case
  2. Providers have no incentives to take an active role in managing cost and utilization
  3. Payors cannot adjust standard case rates to reflect the severity of the patient's condition or complications that arise from multiple medical problems
  4. Payors have the opportunity to benefit from the provider's cost savings

Answer(s): A



Health plans often negotiate compensation arrangements that transfer some or all of the financial risk associated with delivering healthcare services to network providers. The following statements are about these compensation arrangements. Select the answer choice containing the correct statement.

  1. A per diem system typically places a healthcare facility at risk for controlling utilization and costs internally.
  2. One likely reason that an health plan would use a fee schedule system to compensate providers is that this system transfers most of the financial risk to the provider.
  3. Under a salary system, a provider assumes no service risk.
  4. The use of a FFS or a salary system allows an health plan to transfer a greater proportion of financial risk to providers than does the use of capitation.

Answer(s): A



An health plan enters into a professional services capitation arrangement whenever the health plan

  1. Contracts with a medical group, clinic, or multispecialty IPA that assumes responsibility for the costs of all physician services related to a patient's care
  2. Pays individual specialists to provide only radiology services to all plan members
  3. Transfers all financial risk for healthcare services to a provider organization and the provider, in turn, covers virtually all of a patient's medical expenses
  4. Contracts with a primary care provider to cover primary care services only

Answer(s): A



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