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AHIP Exam AHM-530 Topic 3 Question 85 Discussion

Actual exam question for AHIP's AHM-530 exam
Question #: 85
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.

Canyon used a process measure to evaluate the performance of Dr. Enberg when it evaluated whether:

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Suggested Answer: A

by Avery at Apr 25, 2024, 04:02 PM

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Hoa
12 hours ago
Exactly, we must always strive for excellence in healthcare.
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Omega
13 hours ago
For sure, it's crucial for maintaining high-quality healthcare standards.
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Madonna
1 days ago
Yeah, it's a complex but important topic.
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Hoa
2 days ago
No problem, happy to talk about healthcare performance measures.
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Omega
4 days ago
Well, I learned something new today. Thanks for the discussion.
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Madonna
5 days ago
Absolutely, that should always be the priority.
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Hoa
6 days ago
It's all about ensuring quality care for the patients.
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Omega
7 days ago
I agree, it gives a clearer picture of how effective the care is.
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Madonna
8 days ago
Definitely, outcomes measures are crucial in evaluating performance.
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Hoa
9 days ago
Yeah, it's important to consider the outcomes of the treatments provided.
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Omega
10 days ago
I see, I guess it could be C) as well.
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Madonna
11 days ago
Oh, that's interesting. I didn't think of that.
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Hoa
12 days ago
Actually, I believe the answer is C) The condition of one of Dr. Enberg's patients improved after the patient received medical treatment from Dr. Enberg.
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Omega
13 days ago
I'm not sure, I think it might be B) Dr. Enberg's young patients receive appropriate immunizations at the right ages.
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Madonna
14 days ago
I think the answer is A) Dr. Enberg's young patients receive appropriate immunizations at the right ages.
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