AHIP Exam AHM-530 Topic 6 Question 90 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 90
Topic #: 6

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 Leonor at Jun 23, 2024, 05:05 AM

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Ivan

5 months ago

I think A is the correct answer too. Canyon is really digging deep into Dr. Enberg's performance data to make sure she's meeting their standards. Gotta love that attention to detail!

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Larue

3 months ago

Dr. Enberg must really have to stay on top of everything to meet Canyon's standards. A lot of pressure!

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Audry

3 months ago

It's impressive how Canyon uses process measures to ensure quality care. Attention to detail is key.

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Yolando

3 months ago

I agree, A seems like the correct answer. Canyon is really thorough in evaluating Dr. Enberg's performance.

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Pansy

3 months ago

Attention to detail is key when it comes to evaluating healthcare providers like Dr. Enberg. Canyon is definitely thorough.

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Carisa

4 months ago

It's impressive how Canyon is using process measures to ensure Dr. Enberg is meeting their standards.

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Willard

4 months ago

I agree, A seems like the correct answer. Canyon is really thorough in evaluating Dr. Enberg's performance.

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Rory

5 months ago

I agree, it's important to ensure patients are receiving the appropriate care at the right time.

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Maybelle

5 months ago

That makes sense, process measures are usually about assessing the quality of care provided.

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Pearly

5 months ago

Haha, I wonder if Canyon also checked to see if Dr. Enberg's patients were turning into superheroes after their treatments. Outcomes measures are important, but you can't beat a good old-fashioned process measure!

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Krystal

4 months ago

I agree, outcomes measures are crucial, but process measures give a different perspective on performance.

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Davida

4 months ago

Haha, that would be interesting to see! Process measures are definitely important for evaluating performance.

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Robt

5 months ago

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

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Maybelle

5 months ago

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

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Jacki

6 months ago

I agree, A is the right answer. Process measures like immunization rates are important indicators of the quality of care being provided.

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Junita

5 months ago

Yes, process measures like immunization rates can give a good indication of the quality of care being provided. It's an important aspect to consider during recredentialing.

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Sharmaine

5 months ago

I think A is the correct answer too. Immunization rates are crucial for evaluating a provider's performance.

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Lavonda

6 months ago

The correct answer is A. Evaluating whether a provider's young patients receive appropriate immunizations at the right ages is a process measure, as it looks at the steps taken to provide care rather than the actual outcomes.

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Barrett

5 months ago

Exactly, it's not about the outcomes but the process measures.

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Raina

5 months ago

Oh, I see. So it's about the steps taken to provide care.

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Nan

5 months ago

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

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