Free Practice AHIP AHM-530 Exam Questions 2025

The following statement(s) can correctly be made about hospitalists.1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure thatthe patient receives appropriate care while in the hospital.2. The hospitalist’s role clearly supports the health plan concept of disease management. 

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that shecannot sue or file any claims against a Canyon plan member for covered services, even if Canyonbecomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyonwill 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 plandetermine how well she met Canyon's standards. The report included cumulative performancedata for Dr. Enberg and encompassed all measurable aspects of her performance. This reportincluded such information as the number of hospital admissions Dr. Enberg had and the number ofreferrals she made outside of Canyon's provider network during a specified period. Canyon alsoused process measures, structural measures, and outcomes measures to evaluate Dr. Enberg'sperformance.The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon planmember for covered services is known as: 

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

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that shecannot sue or file any claims against a Canyon plan member for covered services, even if Canyonbecomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyonwill 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 plandetermine how well she met Canyon's standards. The report included cumulative performancedata for Dr. Enberg and encompassed all measurable aspects of her performance. This reportincluded such information as the number of hospital admissions Dr. Enberg had and the number ofreferrals she made outside of Canyon's provider network during a specified period. Canyon alsoused process measures, structural measures, and outcomes measures to evaluate Dr. Enberg'sperformance.The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon planmember for covered services is known as: 

The Ionic Group, a provider group with 10,000 plan members, purchased for its hospital risk pool aggregate stop-loss insurance with a threshold of 110% of projected costs and a 10% coinsurance provision. Ionic funds the hospital risk pool at $40 per member per month (PMPM). If Ionic’s actual hospital costs are $5,580,000 for the year, then, under the aggregate stop-loss agreement, the stop-loss insurer is responsible for reimbursing Ionic in the amount of