Absolute Free AHM-530 Exam Practice for Comprehensive Preparation 

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 

With respect to contractual provisions related to provider-patient communications, nonsolicitation clauses prohibit providers from 

One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement. However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method  

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 

The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. One important activity within the scope of network management is ensuring the quality of the health plan’s provider networks. A primary purpose of __ __ is to review the clinical competence of a provider in order to determine whether the provider meets the health plan’s preestablished criteria for participation in the network.