Free AHIP AHM-520 Exam Dumps

MultipleChoice

A health plan can use a SWOT (strengths, weaknesses, opportunities, and threats) analysis to analyze its relationships with the major providers in each market in which it conducts business.

MultipleChoice

A health plan may experience negative working capital whenever healthcare expenses generated by plan members exceed the premium income the health plan receives.

Ways in which a health plan can manage the volatility in claims payments, and therefore reduce the risk of negative working capital, include:

Accurately estimating incurred but not reported (IBNR) claims

Using capitation contracts for provider reimbursement

MultipleChoice

The following information relates to the Hardcastle Health Plan for the month of June:

-Incurred claims (paid and IBNR) equal $100,000 -Earned premiums equal $120,000 -Paid claims, excluding IBNR, equal $80,000 -Total health plan expenses equal $300,000

This information indicates that Hardcastle's medical loss ratio (MLR) for the month of June was approximately equal to:

MultipleChoice

The following transactions occurred at the Lane Health Plan:

-Transaction 1 --- Lane recorded a $25,000 premium prior to receiving the payment -Transaction 2 --- Lane purchased $500 in office expenses on account, but did not record the expense until it received the bill a month later -Transaction 3 --- Fire destroyed one of Lane's facilities; Lane waited until the facility was rebuilt before assessing and recording the amount of loss -Transaction 4 --- Lane sold an investment on which it realized a $14,000 gain; Lane recorded the gain only after the sale was completed.

Of these transactions, the one that is consistent with the accounting principle of conservatism is:

MultipleChoice

The Arista Health Plan is evaluating the following four groups that have applied for group healthcare coverage:

-The Blaise Company, a large private employer -The Colton County Department of Human Services (DHS) -A multiple-employer group comprised of four companies -The Professional Society of Daycare Providers

With respect to the relative degree of risk to Arista represented by these four companies, the company that would most likely expose Arista to the lowest risk is the:

MultipleChoice

The Northwest Company offers its employees the option of choosing to receive their healthcare benefits from an HMO or from a traditional indemnity plan. The premiums for the HMO are lower than for the traditional indemnity plan. In this situation, it is correct to assume that:

Individual low utilizers are more likely to enroll in the traditional indemnity plan

Individual high utilizers are more likely to enroll in the HMO

MultipleChoice

Many clinicians are concerned about the development of practice guidelines that seek to define appropriate healthcare services that should be provided to a patient who has been diagnosed with a specific condition. To avoid the risk associated with using such guidelines, health plans should advise clinicians that the existence of such a guideline:

Establishes standards of care to be routinely utilized with all patients presenting a specific condition

Preempts a physician's judgment when assessing the specific factors related to a patient's condition

MultipleChoice

The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures:

-Preferred provider organization (PPO) -Group model HMO -Staff model health maintenance organization (HMO) -Traditional health insurance

Of these health plan products, the one that would most likely expose a health plan to the highest risk is the:

MultipleChoice

A financial analyst wants to learn the following information about the

Forest health plan for a given financial period:

MultipleChoice

The following statement(s) can correctly be made about a health plan's cash receipts and cash disbursements budgets: