AHIP AHM-520 FAHM Exam Practice Test Instant Access

Question 1

The Column health plan is in the process of developing a strategic plan.

The following statements are about this strategic plan. Three of the statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

AHuman resources most likely will be a critical component of Column's strategic plan because, in health plan markets, the size and the quality of a health plan's provider network is often more important to customers than are the details of a product's benefit design.

BColumn's strategic plan should only address how the health plan will differentiate its products, rather than where and how it will sell these products.

CColumn most likely will need to develop contingency plans to address the need to make adjustments to its original strategic plan.

DColumn's information technology (IT) strategy most likely will be a critical element in successfully implementing the health plan's strategic plan.

Answer : B

Question 2

The medical loss ratio (MLR) for the Peacock health plan is 80%. Peacock's expense ratio is 16%.

One characteristic of Peacock's MLR is that it

AIncludes claims that have been paid but excludes claims that have not yet been reported

BCannot adjust for growth in the health plan's business

CIs the percentage of Peacock's end-of-period surplus to its earned premiums

DMeasures Peacock's overall claims levels

Answer : D

Question 3

The Swann Health Plan excludes mental health coverage from its basic health benefit plan. Coverage for mental health is provided by a specialty health plan called a managed behavioral health organization (MBHO). This arrangement recognizes the fact that distinct administrative and clinical expertise is required to effectively manage mental health services. This information indicates that Swann manages mental health services through the use of a:

AFormulary

BRisk pod

CCarve-out

DCase rate

Answer : C

Question 4

One difference between the internal and external analysis of a health plan's financial information is that

AInternal analysis of the health plan can be more detailed and more specific than can external analysis

BInternal analysts are more likely than external analysts to want comparative financial data about the health plan

COnly internal analysts use trend analysis to analyze the health plan's financial statements

DOnly internal analysts typically conduct the financial analysis of the health plan themselves

Answer : A

Question 5

The theory of vicarious liability or ostensible agency can expose a health plan to the risk that it could be held liable for the acts of independent contractors. Factors that may give rise to the assumption that an agency relationship exists between a health plan and its independent contractors include:

ARequiring the providers to supply their own office space

BEmploying nurses and other healthcare professionals to support the physician providers

CRequiring providers to maintain their own medical records

DAll of the above

Answer : B

Question 6

Because a health plan cannot decline coverage for individuals who are eligible for conversion of group health coverage to individual health coverage, the bulk of the health plan's underwriting for conversion policies is accomplished through health plan design.

ATrue

BFalse

Answer : A

Question 7

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

A$4.17

B$8.33

C$9.17

D$10.00

Answer : B

AHIP Health Plan Finance and Risk Management AHM-520 FAHM Exam Practice Test