Newly Released AHIP AHM-510 Exam PDF

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Question 8

In 1994, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) revised their 1993 healthcare-specific antitrust guidelines to include analytical principles relating to multiprovider networks. Under the new guidelines, the regulatory agencies will use the rule of reason to analyze joint pricing activities by competitors in physician or multiprovider networks only if

Options:

Provider integration under the network is likely to produce significant efficiencies that benefit consumers

The providers in a network share substantial financial risk

The combining of providers into a joint venture enables the providers to offer a new product

All of the above

Question 9

Health plans should monitor changes in the environment and emerging trends, because changes in society will affect the managed care industry. One true statement regarding recent changes in the environment in which health plans operate is that

Options:

Women as a group receive more healthcare and interact more often with health plans than do men over the course of a lifetime

The focus of healthcare during the past decade has shifted away from outpatient care to inpatient hospital treatment

The uninsured population in the United States has been decreasing in recent years

The decline in overall inflation in the 1990s failed to slow the growth in healthcare inflation

Question 10

SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detecting violations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.

By definition, the activity that SoundCare conducted when it examined its strengths, weaknesses, and capabilities is known as

Options:

An environmental analysis

An internal assessment

An environmental forecast

A community analysis

Question 11

The following statements are about various provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Three of the statements are true and one statement is false. Select the answer choice that contains the FALSE statement.

Options:

HIPAA permits group health plans that offer coverage through an HMO to impose affiliation periods during which no benefits or services are provided to a plan member.

HIPAA created a new category of federal healthcare crimes, called federal healthcare offenses that apply to private healthcare plans as well as to federally funded healthcare programs.

One effect of Section 231(h) of HIPAA, which amended the Social Security Act, has been to permit health plans with Medicare contracts to provide enrollees with value-added services such as discounted memberships to health clubs.

HIPAA provides that any fines and penalties recovered through regulatory proceedings to enforce the federal fraud and abuse statutes will be turned over to enforcement agencies to conduct additional investigations.

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Newly Released AHIP AHM-510 Exam PDF,

Exam Code: AHM-510

Exam Name: Governance and Regulation

Last Update: Nov 21, 2024

Questions: 76