AHIP Exam AHM-530 Topic 1 Question 83 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 83
Topic #: 1

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:

ADr. Enberg's young patients receive appropriate immunizations at the right ages

BDr. Enberg's young patients receive appropriate immunizations at the right ages

CThe condition of one of Dr. Enberg's patients improved after the patient received medical treatment from Dr. Enberg

DDr. Enberg's procedures are adequate for ensuring patients' access to medical care

Show Suggested Answer

Suggested Answer: A

by Yuki at Mar 17, 2024, 11:42 AM

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Hubert

5 months ago

I guess it could be related to both options, as long as it's about evaluating Dr. Enberg's performance.

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Nickie

6 months ago

But process measures are usually related to specific actions, like ensuring patients receive necessary care.

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Sunshine

6 months ago

I disagree, I think the answer is B) Dr. Enberg's young patients receive appropriate immunizations at the right ages.

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Hubert

6 months ago

That makes sense, process measures often focus on specific actions or outcomes like immunizations.

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Nickie

6 months ago

I believe the answer is A) Dr. Enberg's young patients receive appropriate immunizations at the right ages.

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Hubert

6 months ago

I think the question is asking about how Dr. Enberg's performance is evaluated by Canyon.

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Kara

6 months ago

I think it was process measures, structural measures, and outcomes measures. They looked at everything from hospital admissions to patient referrals.

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Gayla

7 months ago

But do you guys know what Canyon used to evaluate Dr. Enberg's performance?

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Yolande

7 months ago

I agree with you, Kara. It seems like a one-sided contract.

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Kara

7 months ago

I think it's unfair for Dr. Enberg. She should have the right to sue if Canyon fails to meet its financial obligations.

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Gayla

7 months ago

Yeah, it's strange. But I guess that's part of the contract she signed.

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Yolande

7 months ago

I can't believe Dr. Enberg can't sue or file claims against Canyon plan members.

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