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AHIP AHM-520 Exam Practice Questions (P. 2)

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Question #6
The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for:
  1. A
    All of the diagnostic tests that he ordered on Ms. Pfeiffer
  2. B
    His visits to Ms. Pfeiffer while she was hospitalized
  3. C
    The cost of the services that the specialist performed for Ms. Pfeiffer
  4. D
    All of the above

Correct Answer:
B

Question #7
The Challenger Group is a type of management services organization (MSO) that purchases the assets of physician practices, provides practice management and administrative support services to participating providers, and offers physicians a long-term contract and an equity position in Challenger.
This information indicates that Challenger is a type of health plan:
  1. A
    Known as
  2. B
    An integrated delivery system (IDS)
  3. C
    A medical foundation
  4. D
    A provider-sponsored organization (PSO)
  5. E
    A physician practice management (PPM) company

Correct Answer:
D

Question #8
If the operational budget prepared by the Satilla health plan is typical of most operational budgets, then:
  1. A
    Its purpose is to track Satilla's operations and short-term profitability
  2. B
    The key information source for this operational budget is Satilla's external environment
  3. C
    The time frame for this operational budget is three to five years
  4. D
    Its focus is on the threats that Satilla faces from its external environment

Correct Answer:
A

Question #9
The following statements are about the option for health plan funding known as a self-funded plan. Select the answer choice containing the correct response:
  1. A
    In a self-funded plan, an employer is relieved of all risk associated with paying for the healthcare costs of its employees.
  2. B
    Self-funded plans are subject to the same state laws and regulations that apply to health insurance policies.
  3. C
    Employers electing to self-fund a health plan are required to pay claims from a separate trust established for that purpose.
  4. D
    An employer electing to self-fund a health plan has the option of purchasing stop-loss insurance to transfer part of the financial risk to an insurer.

Correct Answer:
D

Question #10
When pricing its product, the Panda Health Plan assumes a 4% interest rate on its investments. Panda also assumes a crediting interest rate of 4%. The actual interest rate earned by Panda on the assets supporting its product is 6%. The following statements can correctly be made about the investment margin and interest margin for Panda's products.
  1. A
    Panda most likely built the crediting interest rate of 4% into the investment margin of its product.
  2. B
    Panda's investment margin is the difference between its actual benefit costs and the benefit costs that it assumes in its pricing.
  3. C
    The interest margin for this product is 2%.
  4. D
    All of these statements are correct.

Correct Answer:
C

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