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AHIP AHM-520 Exam Dumps - Actual Questions Answers


AHM-520 practice test questions answers

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Health Plan Finance and Risk Management

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AHM-520 Questions and Answers

Question # 1

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

Question # 2

The Kayak Company self funds the health plan for its employees. This plan is an example of a type of self-funded plan known as a general asset plan. The fact that this is a completely self-funded plan indicates that

A.

The plan has no funding vehicle

B.

Kayak passes to its employees the financial risk of providing healthcare coverage

C.

The plan most likely is exempt from ERISA requirements concerning the limits on benefit discrimination for classes of employees

D.

The plan is exempt from the state laws and regulations that apply to health insurance policies

Question # 3

With regard to a health plan's underwriting of groups, it can correctly be stated that, generally, a

A.

Health plan will require that contributory healthcare plans have a participation level of between 50% and 70%

B.

Health plan will decline to cover a group that has been formed for the sole purpose of obtaining healthcare coverage

C.

Health plan's underwriters will not examine the age spread of the entire group being underwritten

D.

Health plan would expect a group with a large proportion of young females to have lower healthcare costs than does a similar group with a large proportion of young males

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