Absolute Free AHM-530 Exam Practice for Comprehensive Preparation 

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which increased the continuity and portability of health insurance coverage. One statement that can correctly be made about HIPAA is that it 

Medicaid beneficiaries pose a challenge for health plans attempting to establish Medicaid provider networks. Compared to membership in commercial health plans, Medicaid enrollees typically 

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:  

provider network. Dr. Comer treats a large number of high-risk patients, whereas Dr. Donne’s

patients are generally healthy and rarely present complications. As a result, Dr. Comer typically

uses medical resources at a much higher rate than does Dr. Donne. In order to equitably compare

Dr. Comer’s performance with Dr. Donne’s performance, the health plan modified its evaluation to

account for differences in the providers’ patient populations and treatment protocols. The health

plan modified Dr. Comer’s and Dr. Donne’s performance data by means of 

The provider contract that Dr. Nick Mancini has with the Utopia Health Plan includes a clause that requires Utopia to reimburse Dr. Mancini on a fee-for-service (FFS) basis until 100 Utopia members have selected him as their primary care provider (PCP). At that time, Utopia will begin reimbursing him under a capitated arrangement. This clause in Dr. Mancini's provider contract is known as: