AHIP AHM-520 Exam Questions

Question 6 of 212

The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for:

All of the diagnostic tests that he ordered on Ms. Pfeiffer

His visits to Ms. Pfeiffer while she was hospitalized

The cost of the services that the specialist performed for Ms. Pfeiffer

All of the above

Correct Answer: B

Question 7 of 212

The Challenger Group is a type of management services organization (MSO) that purchases the assets of physician practices, provides practice management and administrative support services to participating providers, and offers physicians a long-term contract and an equity position in Challenger.
This information indicates that Challenger is a type of health plan:

Known as

An integrated delivery system (IDS)

A medical foundation

A provider-sponsored organization (PSO)

A physician practice management (PPM) company

Correct Answer: D

Question 8 of 212

If the operational budget prepared by the Satilla health plan is typical of most operational budgets, then:

Its purpose is to track Satilla's operations and short-term profitability

The key information source for this operational budget is Satilla's external environment

The time frame for this operational budget is three to five years

Its focus is on the threats that Satilla faces from its external environment

Correct Answer: A

Question 9 of 212

The following statements are about the option for health plan funding known as a self-funded plan. Select the answer choice containing the correct response:

In a self-funded plan, an employer is relieved of all risk associated with paying for the healthcare costs of its employees.

Self-funded plans are subject to the same state laws and regulations that apply to health insurance policies.

Employers electing to self-fund a health plan are required to pay claims from a separate trust established for that purpose.

An employer electing to self-fund a health plan has the option of purchasing stop-loss insurance to transfer part of the financial risk to an insurer.

Correct Answer: D

Question 10 of 212

When pricing its product, the Panda Health Plan assumes a 4% interest rate on its investments. Panda also assumes a crediting interest rate of 4%. The actual interest rate earned by Panda on the assets supporting its product is 6%. The following statements can correctly be made about the investment margin and interest margin for Panda's products.

Panda most likely built the crediting interest rate of 4% into the investment margin of its product.

Panda's investment margin is the difference between its actual benefit costs and the benefit costs that it assumes in its pricing.

The interest margin for this product is 2%.

All of these statements are correct.

Correct Answer: C