Free Practice Questions for AHIP AHM-520 Exam

All of the diagnostic tests that he ordered on Ms. Pfeiffer

His visits to Ms. Pfeiffer while she was hospitalized

The cost of the services that the specialist performed for Ms. Pfeiffer

All of the above

Has only one potential source of funding: borrowing money

Does not pay federal, state, or local taxes on its earnings

Must distribute its earnings to its owners-investors for their personal gain

Is a privately held corporation

Medicare is Ms. Wilson's primary insurer

A Medicare- or Medicaid-contracting health plan is allowed to lock-in Ms. Wilson's enrollment for a maximum period of 24 months

The BBA requires the state to guarantee Ms. Wilson's eligibility for a minimum of 18 months once she enrolls in a health plan network

Ms. Wilson can only receive Medicare- or Medicaid-covered services from a provider who participates in a health plan network

Measuring-unit concept

Full-disclosure concept

Cost concept

Time-period concept

Under this new methodology, Medicare-contracting health plans are paid the lower of (a) a floor payment amount per enrollee covered or (b) the health plan's payment rate increased by 2% from the previous year.

The new methodology has decreased the rate of growth in payments from CMS to Medicare-contracting health plans.

Under this new methodology, Medicare-contracting health plans are paid 90% of the adjusted average per capita cost (AAPCC) of providing a service to a beneficiary.

Under the principal inpatient diagnostic cost group (PIP-DCG), a new risk adjustment methodology, Medicare-contracting health plans will no longer be required to calculate and submit to CMS a Medicare adjusted community rate (ACR).

Panda most likely built the crediting interest rate of 4% into the investment margin of its product.

Panda's investment margin is the difference between its actual benefit costs and the benefit costs that it assumes in its pricing.

The interest margin for this product is 2%.

All of these statements are correct.

Typically, the first step in pricing a PPO is to develop a base indemnity claims cost, which results from adjusting the indemnity plan as though the entire eligible group of employees is enrolled in the indemnity plan.

To develop the expected claims costs for the in-network PPO plan, the health plan's actuaries adjust the base indemnity claims costs to reflect pertinent characteristics of the plan, including the specific network plan design and provider discount arrangements.

One difficulty in pricing a PPO is that the health plan's actuaries have no method of estimating which employees would be likely to select which provider groups.

After the health plan's actuaries use risk adjustment factors to adjust the existing claims costs for selection issues, the actuaries weight the in network and out-of-network costs to arrive at a composite claims cost for the PPO plan.

Anti selection risk is higher for both multiple-employer groups and professional associations than it is for an employer-employee group

Private employers typically present a higher underwriting risk to health plans than do public employers

Individual members of a multiple-employer group or a professional association typically are required to obtain healthcare coverage through the group or association

I health plan is prohibited, when evaluating the risks represented by a professional association, from considering the industry experience of the agent or broker that sells a group plan to the association

McGwire's retention of net income

McGwire's payment of cash dividends on the stock it issued

McGwire's purchase of treasury stock

All of the above

safe harbor law

upper payment limit law

anti-kickback law

physician self-referral law