AHIP Exam AHM-530 Topic 3 Question 85 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 85
Topic #: 3

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 Avery at Apr 25, 2024, 04:02 PM

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Caprice

6 months ago

That makes sense, ensuring patients receive appropriate immunizations is an important aspect of primary care.

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Nelida

7 months ago

I think it was about whether Dr. Enberg's young patients receive appropriate immunizations at the right ages.

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Rory

7 months ago

Do you know what specific process measure Canyon used?

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Nelida

7 months ago

Yes, I believe Canyon used process measures to evaluate her performance.

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Rory

7 months ago

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

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Hoa

7 months ago

Exactly, we must always strive for excellence in healthcare.

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Omega

7 months ago

For sure, it's crucial for maintaining high-quality healthcare standards.

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Madonna

7 months ago

Yeah, it's a complex but important topic.

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Hoa

7 months ago

No problem, happy to talk about healthcare performance measures.

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Omega

7 months ago

Well, I learned something new today. Thanks for the discussion.

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Madonna

8 months ago

Absolutely, that should always be the priority.

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Hoa

8 months ago

It's all about ensuring quality care for the patients.

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Omega

8 months ago

I agree, it gives a clearer picture of how effective the care is.

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Madonna

8 months ago

Definitely, outcomes measures are crucial in evaluating performance.

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Hoa

8 months ago

Yeah, it's important to consider the outcomes of the treatments provided.

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Omega

8 months ago

I see, I guess it could be C) as well.

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Madonna

8 months ago

Oh, that's interesting. I didn't think of that.

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Hoa

8 months 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

8 months 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

8 months ago

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

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