Free AHM-530 Exam Braindumps (page: 18)

Page 17 of 51

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

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

Answer(s): A



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.

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

Answer(s): D



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

  1. Subrogation
  2. Partial capitation
  3. Coordination of benefits
  4. Aremedy provision

Answer(s): A



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

  1. Agree not to sue or file claims against an Octagon plan member for covered services
  2. Reimburse Octagon for costs, expenses, and liabilities incurred by the health plan as a result of a provider's actions
  3. Maintain the confidentiality of the health plan's proprietary information
  4. 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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