QUESTION: 29

Some jurisdictions have enacted corporate practice of medicine laws. One effect that corporate practice of medicine laws have had on HMO provider networks is that these laws typically

require incorporated HMOs to practice medicine through licensed employees
require HMOs to form exclusive contracts with physician groups who agree to dedicate all or most of their practices to HMO patients in return for a set payment or revenue-sharing
restrict the ability of staff model HMOs to hire physicians directly, unless the physicians own the HMO
encourage incorporated HMOs to obtain profits from their provisions of physician professional services

Answer(s): C

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QUESTION: 30

The actual number of providers included in a provider network may be based on staffing ratios. Staffing ratios relate the number of

Potential providers in a plan's network to the number of individuals in the area to be served by the plan
Providers in a plan's network to the number of enrollees in the plan
Providers outside a plan's network to the number of providers in the plan's network
Support staff in a plan's network to the number of medical practitioners in the plan's network

Answer(s): B

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Before incurring the expense of assembling a new PPO network, the Protect Health Plan conducted a cost analysis in order to determine the cost-effectiveness of renting an existing PPO network instead. In calculating the overall cost of renting the network, Protect assumed a premium of $2.52 per member per month (PMPM) and estimated the total number of members to be 9,000. This information indicates that Protect would calculate its annual network rental cost to be

$42,857
$56,700
$272,160
$680,400

Answer(s): C

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QUESTION: 32

The Aegean Health Plan delegated its utilization management (UM) program to the Silhouette IPA. Silhouette, in turn, transferred authority for case management to Brandon Health Services. In this situation, Brandon is best described as the

delegator, and Aegean is ultimately responsible for Brandon's performance
delegator, and Silhouette is ultimately responsible for Brandon's performance
subdelegate, and Aegean is ultimately responsible for Brandon's performance
subdelegate, and Silhouette is ultimately responsible for Brandon's performance

Answer(s): C

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Free AHM-530 Exam Braindumps (page: 9)

QUESTION: 29

QUESTION: 30

QUESTION: 31

QUESTION: 32

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