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 AHM-530 Dumps with Practice Exam Questions Answers

Questions: 202 questions

Last Update: Jun 10, 2024

AHIP Certification Exam AHM-530 has been designed to measure your skills in handling the technical tasks mentioned in the certification syllabus

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AHM-530 Questions and Answers

Question # 1

The Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) established the Programs of All-Inclusive Care for the Elderly (PACE). One characteristic of the PACE programs is that:

A.

They are available to United States citizens only after they reach age 65.

B.

They have an upper dollar limit.

C.

They receive a monthly capitation that is set at 100% of the Adjusted Average Per Capita Cost (AAPCC).

D.

PACE providers receive capitated payments only through the PACE agreement.

Question # 2

The Adobe Health Plan complies with all of the provisions of the Newborns' and Mothers' Health Protection Act (NMHPA) of 1996. Kristen Netzger, an Adobe enrollee, was hospitalized for a cesarean delivery. Amy Davis, also an Adobe enrollee, was hospitalized for a normal delivery. From the following answer choices, select the response that indicates the minimum length of time for which Adobe, under NMHPA, most likely must provide benefits for the hospitalizations of Ms. Netzger and Ms. Davis.

A.

Ms. Netzger = 48 hours

Ms. Davis = 48 hours

B.

Ms. Netzger = 72 hours

Ms. Davis = 72 hours

C.

Ms. Netzger = 96 hours

Ms. Davis = 48 hours

D.

Ms. Netzger = 96 hours

Ms. Davis = 72 hours

Question # 3

Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:

A.

Upcoding

B.

A wrap-around

C.

Churning

D.

Unbundling

Question # 4

Martin Breslin, age 72 and permanently disabled, is classified as dually-eligible. This information indicates that Mr. Breslin qualifies for coverage by both

A.

Medicare and private indemnity insurance, and Medicare provides primary coverage

B.

Medicare and Medicaid, and Medicare provides primary coverage

C.

Medicaid and private indemnity insurance, and Medicaid provides primary coverage

D.

Medicare and Medicaid, and Medicaid provides primary coverage

Question # 5

A provider group purchased from an insurer individual stop-loss coverage for primary and specialty care services with an $8,000 attachment point and 10% coinsurance. If the group's accrued cost for the primary and specialty care treatment of one patient is $10,000, then the amount that the insurer would be responsible for reimbursing the provider group for these costs is:

A.

$200

B.

$1,000

C.

$1,800

D.

$9,000