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Exam Code: AHM-520
Exam Name: Health Plan Finance and Risk Management
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NO.1 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.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 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.4 One true statement about cash-basis accounting is that
A. Cash receipt, but not cash disbursement, is an important component of cash-basis accounting
B. Most companies use a pure cash-basis accounting system
C. Cash-basis accounting records revenue according to the realization principle and expenses
according to the matching principle
D. Health insurance companies and health plans that fall under the jurisdiction of state insurance
commissioners must report some items on a cash basis for statutory reporting purposes
Answer: D
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NO.5 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.6 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.7 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.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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2015年4月13日星期一
AHM-250 Test Answers, AHM-540 Exam Cost
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Exam Code: AHM-250
Exam Name: Healthcare Management: An Introduction
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Exam Code: AHM-540
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NO.1 The measures used to evaluate healthcare quality are generally divided into three categories:
process, structure, and outcomes. An example of a process measure that can be used to evaluate a
health plan's performance is the:
A. Percentage of adult plan members who receive regular medical checkups.
B. Number of plan members contracting an infection in the hospital.
C. Percentage of board certified physicians within the health plan's network.
D. Number of hospital admissions for plan members with certain medical conditions.
Answer: A
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NO.2 Which of the following statements about the Title VII of the Civil Rights Act is WRONG?
A. Employers with more than 15 employees engaged in interstate commerce need to comply
B. Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide
coverage during childbirth and related medical conditions on the same basis as they provide coverage
for other medical conditions
C. Allows HMOs to set different policies for people from different races, religions, sex or national
origin to safeguard their interests.
D. Protects all employees
Answer: C
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NO.3 A public employer, such as a municipality or county government would be considered which of
the following?
A. Employer-employee group
B. Multiple-employer group
C. Affinity group
D. Debtor-creditor group
Answer: A
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NO.4 Medicaid is a jointly funded federal and state program that provides hospital and medical
expense coverage to low-income individuals and certain aged and disabled individuals. One
characteristic of Medicaid is that
A. providers who care for Medicaid recipients must accept Medicaid payment as payment in full for
services rendered
B. Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all
services
C. Medicaid is always the primary payer of benefits
D. benefits offered by Medicaid programs are federally mandated and do not vary by state
Answer: A
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NO.5 The Military Health System of the Department of Defense offers ongoing healthcare coverage
to military personnel and their families through the
A. Health Care Quality Improvement Program (HCQIP)
B. Health Plan Management System (HPMS)
C. TRICARE healthcare system
D. Health Care Prepayment Plan (HCPP)
Answer: C
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NO.6 Bill the member for the balance of the fee above the maximum allowable amount under the fee
schedule reimbursement method
A. UCR fee
B. Capitation fee
C. Balance bill
D. Discounted fee-for-service
Answer: C
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NO.7 Utilization management techniques that most HMOs use for hospital providers include:
A. Discharge planning
B. Case management
C. Co-payment for office visits
D. A & B
Answer: A,B
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NO.8 The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide
A. expert consultation to end-users for solving specialized and complex healthcare problems through
the use of a knowledge-based computer system
B. a comprehensive accreditation for PPOs
C. measurements of plan performance and effectiveness that potential healthcare purchasers can use
to compare quality offered by different healthcare plans
D. a mathematical model that can predict future claim payments and premiums
Answer: C
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Compared with other training materials, why ITCertMaster's AHIP AHM-250 exam training materials is more welcomed by the majority of candidates? First, this is the problem of resonance. We truly understand the needs of the candidates, and comprehensively than any other site. Second, focus. In order to do the things we decided to complete, we have to give up all the unimportant opportunities. Third, the quality of the product. People always determine a good or bad thing based on the surface. We may have the best products of the highest quality, but if we shows it with a shoddy manner, it naturally will be as shoddy product. However, if we show it with both creative and professional manner, then we will get the best result. The ITCertMaster's AHIP AHM-250 exam training materials is so successful training materials. It is most suitable for you, quickly select it please.
Exam Code: AHM-250
Exam Name: Healthcare Management: An Introduction
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AHIP AHM-250 Exam Cost 367 Q&As
Updated: 04-13,2015
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Exam Code: AHM-540
Exam Name: Medical Management
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Updated: 04-13,2015
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NO.1 The measures used to evaluate healthcare quality are generally divided into three categories:
process, structure, and outcomes. An example of a process measure that can be used to evaluate a
health plan's performance is the:
A. Percentage of adult plan members who receive regular medical checkups.
B. Number of plan members contracting an infection in the hospital.
C. Percentage of board certified physicians within the health plan's network.
D. Number of hospital admissions for plan members with certain medical conditions.
Answer: A
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NO.2 Which of the following statements about the Title VII of the Civil Rights Act is WRONG?
A. Employers with more than 15 employees engaged in interstate commerce need to comply
B. Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide
coverage during childbirth and related medical conditions on the same basis as they provide coverage
for other medical conditions
C. Allows HMOs to set different policies for people from different races, religions, sex or national
origin to safeguard their interests.
D. Protects all employees
Answer: C
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NO.3 A public employer, such as a municipality or county government would be considered which of
the following?
A. Employer-employee group
B. Multiple-employer group
C. Affinity group
D. Debtor-creditor group
Answer: A
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NO.4 Medicaid is a jointly funded federal and state program that provides hospital and medical
expense coverage to low-income individuals and certain aged and disabled individuals. One
characteristic of Medicaid is that
A. providers who care for Medicaid recipients must accept Medicaid payment as payment in full for
services rendered
B. Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all
services
C. Medicaid is always the primary payer of benefits
D. benefits offered by Medicaid programs are federally mandated and do not vary by state
Answer: A
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NO.5 The Military Health System of the Department of Defense offers ongoing healthcare coverage
to military personnel and their families through the
A. Health Care Quality Improvement Program (HCQIP)
B. Health Plan Management System (HPMS)
C. TRICARE healthcare system
D. Health Care Prepayment Plan (HCPP)
Answer: C
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NO.6 Bill the member for the balance of the fee above the maximum allowable amount under the fee
schedule reimbursement method
A. UCR fee
B. Capitation fee
C. Balance bill
D. Discounted fee-for-service
Answer: C
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NO.7 Utilization management techniques that most HMOs use for hospital providers include:
A. Discharge planning
B. Case management
C. Co-payment for office visits
D. A & B
Answer: A,B
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NO.8 The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide
A. expert consultation to end-users for solving specialized and complex healthcare problems through
the use of a knowledge-based computer system
B. a comprehensive accreditation for PPOs
C. measurements of plan performance and effectiveness that potential healthcare purchasers can use
to compare quality offered by different healthcare plans
D. a mathematical model that can predict future claim payments and premiums
Answer: C
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