AHIP AHM-520 - Health Plan Finance and Risk Management Exam
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Total 215 questions
Question #1 (Topic: Topic 1)
The methods of alternative funding for health coverage can be divided into the following
general categories:
? Category A—Those methods that primarily modify traditional fully insured group
insurance contracts
? Category B—Those methods that have either partial or total self funding
Typically, small employers are able to use some of the alternative funding methods in
general categories:
? Category A—Those methods that primarily modify traditional fully insured group
insurance contracts
? Category B—Those methods that have either partial or total self funding
Typically, small employers are able to use some of the alternative funding methods in
A. Both Category A and Category B
B. Category A only
C. Category B only
D. Neither Category A nor Category B
Answer: C
Question #2 (Topic: Topic 1)
The Marble Health Plan sets aside a PMPM amount for each specialty.
When a PCP in Marble's provider network refers a Marble plan member to a specialist and
the specialist provides medical services to the member, the specialist begins to receive a
share of those funds on a monthly basis. Marble determines the monthly payment for each
specialist by dividing the number of active patients for that specialty by the total specialty
pool for that month.
This form of payment, which is similar to a case rate, is known as
When a PCP in Marble's provider network refers a Marble plan member to a specialist and
the specialist provides medical services to the member, the specialist begins to receive a
share of those funds on a monthly basis. Marble determines the monthly payment for each
specialist by dividing the number of active patients for that specialty by the total specialty
pool for that month.
This form of payment, which is similar to a case rate, is known as
A. Referral circle capitation
B. Risk pod capitation
C. Contact capitation
D. Retrospective reimbursement capitation
Answer: C
Question #3 (Topic: Topic 1)
A health plan that capitates a provider group typically provides or offers to provide stop-loss
coverage to that provider group.
coverage to that provider group.
A. True
B. False
Answer: A
Question #4 (Topic: Topic 1)
State A, which requires guaranteed issue of at least two mandated healthcare plans, has
established a typical health coverage reinsurance program for small employer groups. One
true statement about this reinsurance program is that it most likely
established a typical health coverage reinsurance program for small employer groups. One
true statement about this reinsurance program is that it most likely
A. is administered by a commercial reinsurance company that operates in State A
B. allows a small employer carrier operating in State A to reinsure either an entire small group or specific individuals within the group
C. has, for the coverage on a plan, a base premium, which is multiplied by a factor of 2 in the case of reinsurance on entire groups or a factor of 3 for reinsurance on individuals
D. prohibits a small employer carrier operating in State A from placing individuals enrolled in small groups in a reinsurance pool
Answer: B
Question #5 (Topic: Topic 1)
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
