QUESTION: 81

The method that the Autumn Health Plan uses for reimbursing dermatologists in its provider network involves paying them out of a fixed pool of funds that is actuarially determined for this specialty. The amount of funds that Autumn allocates to dermatologists is based on utilization and costs of services for that discipline.

Under this reimbursement method, a dermatologist who is under contract to Autumn accumulates one point for each new referral made to the specialist by Autumn's PCPs. If the referral is classified as complicated, then the dermatologist receives 1.5 points. The value of Autumn's dermatology services fund for the first quarter was $15,000. During the quarter, Autumn's PCPs made 90 referrals, and 20 of these referrals were classified as complicated.

In determining the first quarter payment to dermatologists, Autumn would accurately calculate the value of each referral point to be

$111.11
$125.00
$150.00
$166.67

Answer(s): C

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QUESTION: 82

Dr. Janet Dubois is a radiologist who practices exclusively at the Rightway Healthcare Center. This information indicates that Dr. Dubois is employed by Rightway as

An academic practitioner
An independent practitioner
Anetwork manager
Ahospital-based specialist

Answer(s): D

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QUESTION: 83

Promise, Inc., a corporation that specializes in cancer services, employs its physicians and support staff and provides facilities and ancillary services for cancer patients. Promise has contracted with the Cordelia Health Plan to provide all specialty services for Cordelia plan members who are undergoing cancer treatment. In return, Promise receives a capitated amount from Cordelia. Promise is an example of a type of specialty services organization known as a

Specialty IPA
Disease management company
Single specialty management specialist
Specialty network management company

Answer(s): B

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QUESTION: 84

If the Oconee Health Plan reimburses its specialty care physicians (SCPs) under a typical retainer method, then Oconee pays SCPs

Aseparate amount for each service provided, and the payment amount is based solely on a resource-based relative value scale (RBRVS)
Aspecified fee that remains the same regardless of how much or how little time or effort is spent on the medical service performed
Aset amount each month, and Oconee reconciles its payment at periodic intervals on the basis of actual utilization
Aset amount of cash equivalent to a defined time period's expected reimbursable charges

Answer(s): C

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Free AHM-530 Exam Braindumps (page: 22)

QUESTION: 81

QUESTION: 82

QUESTION: 83

QUESTION: 84

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