Free AHM-530: Network Management Exam Questions and Answers

Last updated: September 12, 2026

Exam code

AHM-530

Provider

AHIP

Questions in our bank

1000+

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First 10, with answers

Official page

Official Exam website

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130 mins · 70%

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1. Question #1

   - (Topic 1) With respect to hiring practices, one step that a health plan most likely can take to avoid violating the terms of the Americans with Disabilities Act (ADA) is to

   • A. Include in the employment application questions pertaining to health status
   • B. Require a medical examination prior to accepting an application for employment
   • C. Make a conditional offer of employment, and then require the candidate to have an examination prior to granting specific staff privileges
   • D. Require applicants to answer questions pertaining to the use of drugs and alcohol
   Reveal Answer

2. Question #2

   - (Topic 1) The following statements are about the responsibilities that providers are expected to assume under most provider contracts with health plans. Select the answer choice containing the correct statement.

   • A. All health plans now include in their provider contracts a statement that explicitly places responsibility for the medical care of plan members on the health plan
   • B. Most provider contracts require participating providers to discuss health plan payment arrangements with patients who are covered by the plan.
   • C. According to the wording of most provider contracts, the responsibility of providers to deliver medical services to a plan member is not contingent upon the
   • D. Most health plans include in their provider contracts a clause which requires providers to maintain open communication with plan members regarding
   Reveal Answer

3. Question #3

   - (Topic 1) One type of fee schedule payment system assigns a weighted unit value for each medical procedure or service based on the cost and intensity of that service. Under this system, the unit values for procedural services are generally higher than the unit values for cognitive services. This system is known as a

   • A. Wrap-around payment system
   • B. Capped fee system
   • C. Relative value scale (RVS) payment system
   • D. Resource-based relative value scale (RBRVS) system
   Reveal Answer

4. Question #4

   - (Topic 2) Dr. Michelle Kubiak has contracted with the Gem Health Plan, a Medicare+Choice health plan, to provide medical services to Gem's enrollees. Gem pays Dr. Kubiak $40 per enrollee per month for providing primary care. Gem also pays her an additional $10 per enrollee per month if the cost of referral services falls below a targeted level. This information indicates that, according to the substantial financial risk formula, Dr. Kubiak's referral risk under this contract is equal to:

   • A. 25%, and therefore this arrangement puts her at substantial financial risk
   • B. 20%, and therefore this arrangement does not put her at substantial financial risk
   • C. 20%, and therefore this arrangement puts her at substantial financial risk
   • D. 25%, and therefore this arrangement does not put her at substantial financial risk
   Reveal Answer

5. Question #5

   - (Topic 2) The Blanchette Health Plan uses a method of claims submission that allows its providers to submit claims directly to Blanchette through a computer application-to- application exchange of claims using a standard data format. This information indicates that Blanchette allows its providers to submit claims using technology known as

   • A. An electronic referral system
   • B. Encounter reporting
   • C. Telemedicine
   • D. Electronic data interchange
   Reveal Answer

6. Question #6

   - (Topic 2) The following statement(s) can correctly be made about financial arrangements between health plans and emergency departments of hospitals:

   • A. A only
   • B. Both A and B
   • C. These arrangements typically include payments for services rendered in the emergency department by a health plan's primary or specialty care providers.
   • D. Most of these arrangements are structured through the health plan's contract with the hospital.
   Reveal Answer

7. Question #7

   - (Topic 2) The Foxfire Health Plan, which has 20,000 members, contracts with dermatologists on a contact capitation basis. The contact capitation arrangement has the following features: Foxfire distributes the money in the contact capitation fund once each quarter and the distribution is based on the point totals accumulated by each dermatologist. Foxfire's per member per month (PMPM) capitation for dermatology services is $1. The dermatologist receives 1 point for each new referral that is not classified as a complicated referral and 1.5 points for each new referral that is classified as complicated. During the first quarter, Foxfire's PCPs made 450 referrals to dermatologists and 100 of these referrals were classified as complicated. One dermatologist, Dr. Shareef Rashad, received 42 of these referrals; 6 of his referrals were classified as complicated. Statements that can correctly be made about Foxfire's contact capitation arrangement include:

   • A. that the value of each referral point for the first quarter was $120
   • B. Rashad for the first quarter was $6,120
   • C. that the value of Foxfire's contact capitation fund for dermatologists for the first quarter was $20,000
   • D. that the payment that Foxfire owed D
   Reveal Answer

8. Question #8

   - (Topic 2) The following statement(s) can correctly be made about the Balanced Budget Act (BBA) of 1997:

   • A. The BBA requires Medicare+Choice organizations to be licensed as non-risk-bearing entities under federal law.
   • B. Both A and B
   • C. A only
   • D. The Centers for Medicaid and Medicare Services (CMS) is responsible for implementing the BBA.
   Reveal Answer

9. Question #9

   - (Topic 2) Assume that the national average cost per covered employee for PPO rental networks is $3 per member per month (PMPM) and that the average monthly healthcare premium PMPM is $300. This information indicates that, if the number of health plan members is 10,000, then the annual network rental cost to the health plan would be:

   • A. $9,000,000
   • B. $12,000,000
   • C. $30,000
   • D. $360,000
   Reveal Answer

10. Question #10

    - (Topic 1) From the following answer choices, choose the type of clause or provision described in this situation. The provider contract between Dr. Olin Norquist and the Granite Health Plan specifies a time period for the party who has breached the contract to remedy the problem and avoid termination of the contract.

    • A. Evergreen clause
    • B. Hold-harmless provision
    • C. Exculpation clause
    • D. Cure provision
    Reveal Answer