QUESTION: 101

An increasing number of health plans offer coverage for alternative healthcare services. One such alternative healthcare service is biofeedback. Biofeedback is an approach that

is based on an ancient Chinese system of healing in which needles are inserted into specific sites on the body to relieve pain
treats diseases with tiny doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated
uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate and body temperature
incorporates a variety of therapies, such as homeopathy, lifestyle modification, and herbal medicines, to support and maintain the body's ability to heal itself

Answer(s): C

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The provider contract that the Danube Health Plan has with the Viola Home Health Services Organization states that Danube will use a typical flat rate reimbursement arrangement to compensate Viola for the skilled nursing services it provides to Danube's plan members. A portion of the contract's reimbursement schedule is shown below:

Home Health Licensed Practical Nurse (LPN): $45 per visit or $90 per diem Home Health Registered Nurse (RN): $50 per visit or $110 per diem
Last month, an LPN from Viola visited a Danube plan member and provided 1Ѕ hours of home healthcare, and an RN from Viola visited another Danube plan member and provided 7 hours of home healthcare. The following statement(s) can correctly be made about Danube's payment to Viola for these services:

A) Danube most likely owes $90 for the LPN's skilled nursing services and $110 for the RN's skilled nursing services.
B) Danube's payment amount could be different from the amount called for in the reimbursement schedule if the level of care provided to one of these plan members was significantly different from the level of care normally provided by Viola's RNs and LPNs.

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

Answer(s): C

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QUESTION: 103

Prior to the enactment of the Balanced Budget Act (BBA) of 1997, payment for Medicare-covered primary and acute care services was based on the adjusted average per capita cost (AAPCC).
The AAPCC is defined as the

average cost of services delivered to all patients living in a specified geographic region
actuarial value of the deductible and coinsurance amounts for basic Medicare-covered benefits
fee-for-service amount that the Centers for Medicaid and Medicare Services (CMS) would pay for a Medicare beneficiary, adjusted for age, sex, and institutional status
average fixed monthly fee paid by all Medicare enrollees in a specified geographic region

Answer(s): C

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QUESTION: 104

The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 allowed competitive medical plans (CMPs) to participate in the Medicare program on a risk basis. Under the terms of Medicare risk contracts, CMPs were required to deliver all medically necessary Medicare-covered services in return for a

fixed monthly capitation payment from CMS
fee-for-service payment from the appropriate state Medicare agency
mandatory premium paid by plan enrollees
fee equal to twice the actuarial value of the Medicare deductible and coinsurance paid by plan enrollees

Answer(s): A

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Free AHM-530 Exam Braindumps (page: 27)

QUESTION: 101

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QUESTION: 103

QUESTION: 104

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