QUESTION: 65

With respect to contractual provisions related to provider-patient communications, nonsolicitation clauses prohibit providers from

Encouraging patients to switch from one health plan to another
Disclosing confidential information about the health plan's reimbursement structure
Dispersing confidential financial information regarding the health plan
Discussing alternative treatment plans with patients

Answer(s): A

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The provider contract that Dr. Huang Kwan has with the Poplar Health Plan includes a typical scope of services provision. The medical service that Dr. Kwan provided to Alice Meyer, a Poplar plan member, is included in the scope of services. The following statement(s) can correctly be made about this particular medical service:

A) Dr. Kwan most likely was required to seek authorization from Poplar before performing this particular service.
B) Dr. Kwan most likely was paid on a FFS basis for providing this service.

Both A and B
A only
B only
Neither A nor B

Answer(s): D

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QUESTION: 67

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

Subrogation
Partial capitation
Coordination of benefits
Aremedy provision

Answer(s): A

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QUESTION: 68

The Octagon Health Plan includes a typical indemnification clause in its provider contracts. The purpose of this clause is to require Octagon's network providers to

Agree not to sue or file claims against an Octagon plan member for covered services
Reimburse Octagon for costs, expenses, and liabilities incurred by the health plan as a result of a provider's actions
Maintain the confidentiality of the health plan's proprietary information
Agree to accept Octagon's payment as payment in full and not to bill members for anything other than contracted copayments, coinsurance, or deductibles

Answer(s): B

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Free AHM-530 Exam Braindumps (page: 18)

QUESTION: 65

QUESTION: 66

QUESTION: 67

QUESTION: 68

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