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Exam Code:
AHM-520Exam Name: Health Plan Finance and Risk Management
One year free update, No help, Full refund!
AHM-520 Test Questions Total Q&A: 215 Questions and Answers
Last Update: 03-23,2015
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NO.1 The Caribou health plan is a for-profit organization. The financial
statements that Caribou
prepares include balance sheets, income statements,
and cash flow statements. To prepare its cash
flow statement, Caribou begins
with the net income figure as reported on its income statement and
then
reconciles this amount to operating cash flows through a series of adjustments.
Changes in
Caribou's cash flow occur as a result of the health plan's
operating activities, investing activities, and
financing activities.
The
main purpose of Caribou's balance sheet is to
A. Reveal how Caribou obtained
particular assets or liabilities
B. Show how much money Caribou has realized
from its operations during an accounting period
C. Measure the owners'
wealth
D. Reconcile the cash that Caribou has on hand at the beginning and at
the end of an accounting
period
Answer:
C
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NO.2 The Acorn Health Plan uses a
resource-based relative value scale (RBRVS) to help determine
the
reimbursement amounts that Acorn should make to providers who are
compensated under an FFS
system. With regard to the advantages and
disadvantages to Acorn of using RBRVS, it can correctly be
stated that
A.
An advantage of using RBRVS is that it can assist Acorn in developing
reimbursement schedules for
various types of providers in a comprehensive
healthcare plan
B. An advantage of using RBRVS is that it puts providers who
render more medical services than
necessary at financial risk for this
overutilization
C. A disadvantage of using RBRVS is that it will be difficult
for Acorn to track treatment rates for the
health plan's quality and cost
management functions
D. A disadvantage of using RBRVS is that it rewards
procedural healthcare services more than
cognitive healthcare
services
Answer: A
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NO.3 The following
information was presented on one of the financial statements prepared by
the
Rouge health plan as of December 31, 1998:
When calculating its
cash-to-claims payable ratio, Rouge would correctly divide its:
A. Cash by
its reported claims only
B. Cash by its reported claims and its incurred but
not reported claims (IBNR)
C. Reported claims by its cash
D. Reported
claims and its incurred but not reported claims (IBNR) by its cash
Answer:
B
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NO.4 Several federal agencies establish rules and
requirements that affect health plans. One of these
agencies is the
Department of Labor (DOL), which is primarily responsible for _________.
A.
Issuing regulations pertaining to the Health Insurance Portability and
Accountability Act (HIPAA) of
1996
B. Administering the Medicare and
Medicaid programs
C. Administering ERISA, which imposes various
documentation, appeals, reporting, and disclosure
requirements on employer
group health plans
D. Administering the Federal Employees Health
BenefitsProgram (FEHBP), which providesvoluntary
health insurance coverage to
federal employees, retirees, and dependents
Answer:
C
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NO.5 Federal law
addresses the relationship between Medicare- or Medicaidcontracting health
plans
and providers who are at "substantial financial risk."
Under federal
law, Medicare- or Medicaid-contracting health plans
A. Place a provider at
"substantial risk" whenever incentive arrangements put the provider at risk
for
amounts in excess of 10% of his or her total potential reimbursement for
providing services to
Medicare and Medicaid enrollees
B. Must provide
stop-loss coverage to a provider who is placed at "substantial financial risk"
for
services that the provider does not directly provide to Medicare or
Medicaid enrollees
C. Both A and B
D. A only
E. B only
F. Neither A
nor B
Answer: C
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NO.6 The sentence below contains two pairs of words
enclosed in parentheses. Determine which
word in each pair correctly
completes the statement. Then select the answer choice containing the
two
words that you have chosen. Purchasing stop-loss coverage most likely (increases
/ reduces) a
health plan's underwriting risk and (increases / reduces) the
health plan's affiliate risk.
A. increases / increases
B. increases /
reduces
C. reduces / increases
D. reduces / reduces
Answer:
C
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NO.7 The
Fiesta Health Plan prices its products in such a way that the rates for its
products are
reasonable, adequate, equitable, and competitive. Fiesta is
using blended rating to calculate a
premium rate for the Murdock Company, a
large employer. Fiesta has assigned a credibility factor of
0.6 to Murdock.
Fiesta has also determined that Murdock's manual rate is $200 PMPM and
that
Murdock's experience rate is $180 PMPM. Fiesta would correctly calculate
that its blended rate
PMPM for Murdock should be Fiesta's retention charge
plus
A. $152
B. $188
C. $192
D. $228
Answer:
B
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NO.8 The Lindberg
Company has decided to terminate its group healthcare coverage with the
Benson
Health Plan. Lindberg has several former employees who previously
experienced qualifying events
that caused them to lose their group coverage.
One federal law allows these former employees to
continue their group
healthcare coverage. From the answer choices below, select the response
that
correctly identifies the federal law that grants these individuals with
the right to continue group
healthcare coverage, as well as the entity which
is responsible for continuing this coverage:
A. Federal law: Consolidated
Omnibus Budget Reconciliation Act (COBRA) Entity: Lindberg
B. Federal law:
Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Benson
C.
Federal law: Employee Retirement Income Security Act (ERISA) Entity:
Lindberg
D. Federal law: Employee Retirement Income Security Act (ERISA)
Entity: Benson
Answer: A
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