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AHIP AHM-510 Exam
- Topic 1: Review relevant terms, industry issues, case scenarios and concepts/ Understand the legal issues surrounding ERISA, pharmacy benefits, and wellness
- Topic 2: Dig deep into the role of health insurance providers in providing services to both Medicare and Medicaid enrollees/ Examine legal issues faced by health insurance providers in a post-reform environment
- Topic 3: Learn the role of the federal government as a purchaser of health care benefits/ Explore factors shaping the health insurance industry, its formation, types of insurance, and structure
- Topic 4: Delve into federal and state regulatory requirements that affect health insurance providers/ Analyze how fraud and abuse affect health care?s cost and quality
- Topic 5: Explore how health insurance providers use organizational control systems to build internal structures that meet external demands for accountability
- Topic 6: Understand how health insurance providers use reorganization, reengineering, and strategic planning to improve performance
Free AHIP AHM-510 Exam Actual Questions
The questions for AHM-510 were last updated On Apr. 13, 2024
The Westchester Health Plan is using a pricing strategy that involves setting a low price in a highly price-sensitive market to stimulate revenue growth. In following this strategy, Westchester is sacrificing short-term profits for fast growth in selected markets. This information indicates that Westchester is following the pricing strategy known as
In examining accountability in the current managed care environment, one is likely to find that combinations of various models of accountability are in operation. Under one model of accountability, the primary mechanisms for accountability are the mechanisms of the marketplace failure to meet standards will result in a loss of demand for services. By definition, this model of accountability is called the
SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detecting violations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.
With respect to the Federal Sentencing Guidelines, actions that SoundCare should take in developing its compliance program include
The Hanford Health Plan has delegated the credentialing of its providers to the Sienna Group, a credential verification organization (CVO). If the contract between Hanford and Sienna complies with all of the National Committee for Quality Assurance (NCQA) guidelines for delegation of credentialing, then this contract
Brighton Health Systems, Inc., a health plan, wants to modify its advertising and marketing materials to avoid liability risk under the principle of ostensible agency. One step that Brighton can take to reduce the likelihood of being liable for provider negligence under the theory of ostensible agency is to
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