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AHIP AHM-530 Exam - Topic 3 Question 22 Discussion

Actual exam question for AHIP's AHM-530 exam
Question #: 22
Topic #: 3
[All AHM-530 Questions]

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that she cannot sue or file any claims against a Canyon plan member for covered services, even if Canyon becomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyon will compensate her under a typical discounted fee-for-service (DFFS) payment system.

During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plan determine how well she met Canyon's standards. The report included cumulative performance data for Dr. Enberg and encompassed all measurable aspects of her performance. This report included such information as the number of hospital admissions Dr. Enberg had and the number of referrals she made outside of Canyon's provider network during a specified period. Canyon also used process measures, structural measures, and outcomes measures to evaluate Dr. Enberg's performance.

The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon plan member for covered services is known as:

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Suggested Answer: B

by Theola at May 05, 2022, 09:00 PM

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Barney
5 months ago
I wonder how often these clauses actually come into play.
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Jeannine
5 months ago
Totally agree, it's a standard practice in these contracts.
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Kenda
5 months ago
Wait, can they really prevent her from suing? Sounds weird.
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Temeka
5 months ago
I thought it was an indemnification clause?
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Socorro
5 months ago
That's definitely a hold-harmless clause!
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Lynna
6 months ago
I think Option A with the multiple resource pools and local storage is the way to go. That should give us the scalability and fault tolerance the requirements are looking for.
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Keneth
6 months ago
I feel a bit unsure about the specific options. I think I need to recall how tolerable rates come into play with deviation rates.
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Roosevelt
6 months ago
Okay, I think I've got a handle on this. The key is to find the code fragment that will properly handle the null check and print the desired output. Let me work through the options.
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Scarlet
6 months ago
I remember there was a similar practice question about loss carrybacks, and I think the key is to apply it in reverse order, but I can't fully recall the exact calculations.
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Jacklyn
6 months ago
Hmm, I'm a bit confused by this question. I'm not too familiar with the details of B-VPLS and I-VPLS configurations. I'll need to re-read the question and the exhibit a few times to make sure I understand what's being asked.
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Merissa
6 months ago
I remember that you can apply filters to limit the captured traffic, which would help with the disk space issue. I just can't recall which commands do that.
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Katina
6 months ago
Hmm, I'm not totally sure about this one. The options seem pretty similar - risk management, risk evaluation, and risk control. I'll have to think this through carefully before answering.
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Bernadine
6 months ago
I'm a bit confused by the wording here. Is asymmetric routing the same as full tunneling? I'll need to review my networking concepts to be sure.
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