AHM-520 AHIP Exam Questions and Free Practice Test

Question 7

- (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

A. Referral circle capitation

B. Risk pod capitation

C. Contact capitation

D. Retrospective reimbursement capitation

Correct Answer:C

Question 8

- (Topic 2)
In a comparison of small employer-employee groups to large employer-employee groups, it is correct to say that small employer-employee groups tend to:

A. More closely follow actuarial predictions with respect to morbidity rates

B. Generate more administrative expenses as a percentage of the total premium amount the group pays

C. Have less frequent and smaller claims fluctuations

D. Expose an health plan to a lower risk of anti selection

Correct Answer:B

Question 9

- (Topic 1)
One true statement about the rate ratios used by a health plan is that the

A. End result of a typical family rate ratio is that the health plan's family rate is subsidized by its single premium rate

B. health plan cannot arbitrarily increase or decrease its rate ratio for a rate category

C. rate ratios used by the health plan most likely have been established by government regulations

D. health plan should determine its rate ratios by considering family size alone rather than competitive factors such as the ratios that competitors are using

Correct Answer:A

Question 10

- (Topic 1)
Reconciliation is the process by which a health plan assesses providers' performance relative to contractual terms and reimbursement.
With regard to this process, it can correctly be stated that

A. Areconciliation typically includes payment to the providers of any withholds or bonuses due to them

B. Ahealth plan typically should conduct a reconciliation immediately after the evaluation period has ended

C. Most agreements between health plans and providers require reconciliations to be performed quarterly

D. Ahealth plan typically should not conduct reconciliation for a provider until the plan has received all claims or other documentation of services that the physician provided during the evaluation period

Correct Answer:A

Question 11

- (Topic 2)
Ways in which a company can increase its return on investment (ROI) include: 1.Reducing expenses to increase operating income 2.Increasing controllable investment

A. Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

Correct Answer:B

Question 12

- (Topic 1)
With regard to capitation arrangements for hospitals, it can correctly be Back to Top stated that

A. The most common reimbursement method for hospitals is professional services capitation

B. Most jurisdictions prohibit hospitals and physicians from joining together to receive global capitations that cover institutional services provided by the hospitals

C. Ahealth plan typically can capitate a hospital for outpatient laboratory and X-ray services only if the health plan also capitates the hospital for inpatient care

D. Many hospitals have formed physician hospital organizations (PHOs), hospital systems, or integrated delivery systems (IDSs) that can accept global capitation payments from health plans

Correct Answer:D

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