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AHIP AHM-520 Practice Test Questions Answers

Exam Code: AHM-520 (Updated 215 Q&As)
Exam Name: Health Plan Finance and Risk Management
Last Update: 18-Sep-2025
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  • Single Choice: 215 Q&A's

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    AHM-520 Questions and Answers

    Question # 1

    Under the alternative funding method used by the Flair Company, Flair assumes financial responsibility for paying claims up to a specified level and deposits the funds necessary to pay these claims into a bank account that belongs to Flair. However, an insurer, which acts as an agent of Flair, makes the actual payment of claims from this account. When claims exceed the specified level, the insurer pays the balance from its own funds. No state premium tax is levied on the amounts that Flair deposits into this bank account.

    From the following answer choices, choose the name of the alternative funding method described.

    A.

    Retrospective-rating arrangement

    B.

    Premium-delay arrangement

    C.

    Reserve-reduction arrangement

    D.

    Minimum-premium plan

    Question # 2

    The Atoll Health Plan must comply with a number of laws that directly affect the plan's contracts. One of these laws allows Atoll's plan members to receive medical services from certain specialists without first being referred to those specialists by a primary care provider (PCP). This law, which reduces the PCP's ability to manage utilization of these specialists, is known as _________.

    A.

    A due process law

    B.

    An any willing provider law

    C.

    A direct access law

    D.

    A fair procedure law

    Question # 3

    With regard to the financial statements prepared by health plans, it can correctly be stated that

    A.

    both for-profit, publicly owned health plans and not-for-profit health plans are required by law to provide all interested parties with an annual report

    B.

    a health plan's annual report typically includes an independent auditor's report and notes to the financial statements

    C.

    any health plan that owns more than 20% of the stock of a subsidiary company must compile the financial statements for the health plan's annual report on a consolidated basis

    D.

    a health plan typically must prepare the financial statements included in its annual report according to SAP

    Question # 4

    Over time, health plans and their underwriters have gathered increasingly reliable information about the morbidity experience of small groups.

    Generally, in comparison to large groups, small groups tend to

    A.

    Have more frequent and larger claims fluctuations

    B.

    Generate lower administrative expenses as a percentage of the total premium amount the group pays

    C.

    More closely follow actuarial predictions regarding morbidity rates

    D.

    All of the above

    Question # 5

    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

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