Free AHIP AHM-520 Exam Dumps

MultipleChoice

The following statements indicate the pricing policies of two health plans that operate in a particular market:

-The Accent Health Plan consistently underprices its product -The Bolton Health Plan uses extremely strict underwriting practices for the small groups to which it markets its plan

From the following answer choices, select the response that correctly indicates the most likely market effects of the pricing policies used by Accent and Bolton.

MultipleChoice

The following statement(s) can correctly be made about a health plan's underwriting of small groups:

MultipleChoice

The following statements illustrate the use of different rating methods by health plans:

-The Dover health plan established rates for small groups by using a rating method which requires that the average premium in each group cannot be more than 120% of the average premium for any other group. Under this method, all members of each group pay the same premium, which is based on the experience of the group.

-Under the rating method used by the Rolling Hills health plan, the health plan calculates the ratio of a group's experience to the group's historical manual rate. Rolling Hills then multiplies this ratio by the group's future manual rate. Rolling Hills cannot consider the group's experience in determining premium rates.

From the following answer choices, select the response that correctly indicates the rating methods used by Dover and Rolling Hills.

MultipleChoice

Federal law addresses the relationship between Medicare- or Medicaid contracting health plans and providers who are at 'substantial financial risk.'

Under federal law, Medicare- or Medicaid-contracting health plans

MultipleChoice

In order to calculate a simple monthly capitation payment, the Argyle Health Plan used the following information:

-The average number of office visits each member makes in a year is two -The FFS rate per office visit is $55 -The member copayment is $5 per office visit -The reimbursement period is one month

Given this information, Argyle would correctly calculate that the per member per month (PMPM) capitation rate should be

MultipleChoice

Rasheed Azari, the risk manager for the Tower health plan, is attempting to work with providers in the organization in order to reduce the providers' exposure related to utilization review. Mr. Azari is considering advising the providers to take the following actions:

-1-Allow Tower's utilization management decisions to override a physician's independent medical judgment

-2-Support the development of a system that can quickly render a second opinion in case of disagreement surrounding clinical judgment

-3-Inform a patient of any issues that are being disputed relative to a physician's recommended treatment plan and Tower's coverage decision

Of these possible actions, the ones that are likely to reduce physicians' exposures related to utilization review include actions

MultipleChoice

Users of the Fulcrum Health Plan financial information include:

-The independent auditors who review Fulcrum's financial statements -Fulcrum's controller (comptroller) -Fulcrum's plan members -The providers that deliver healthcare services to Fulcrum plan members -Fulcrum's competitors

Of these users, the ones that most likely can correctly be classified as external users with a direct financial interest in Fulcrum are the