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 AHM-520 Dumps with Practice Exam Questions Answers

Questions: 215 questions

Last Update: Jun 21, 2024

AHIP Certification Exam AHM-520 has been designed to measure your skills in handling the technical tasks mentioned in the certification syllabus

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AHM-520 Questions and Answers

Question # 1

The Rathbone Company has contracted with the Jarvin Insurance Company to provide healthcare benefits to its employees. Under this contract, Rathbone assumes financial responsibility for paying 80% of its estimated annual claims and for depositing the funds necessary to pay these claims into a bank account. Although Rathbone owns the bank account, Jarvin, acting as Rathbone’s agent, makes the actual claims payments from this account. Claims in excess of Rathbone’s contracted percentage are paid by Jarvin. Rathbone pays to Jarvin a premium for administering the entire plan and bearing the costs of claims in excess of Rathbone’s obligation. This premium is substantially lower than would be charged if Jarvin were providing healthcare coverage under a traditional fully insured group plan. Jarvin is required to pay premium taxes only on the premiums it receives from Rathbone. This information indicates that the type of alternative funding method used by Rathbone is known as a:

A.

Premium-delay arrangement

B.

Reserve-reduction arrangement

C.

Minimum-premium plan

D.

Retrospective-rating arrangement

Question # 2

A health plan can use cost accounting in order to

A.

Determine premium rates for its products

B.

Match the costs incurred during a given accounting period to the income earned in, or attributed to, that same period

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Question # 3

A health plan can use segment margins to evaluate the profitability of its profit centers. One characteristic of a segment margin is that this margin

A.

Is the portion of the contribution margin that remains after a segment has covered its direct fixed costs

B.

Incorporates only the costs attributable to a segment, but it does not incorporate revenues

C.

Considers only a segment's costs that fluctuate in direct proportion to changes in the segment's level of operating activity

D.

Evaluates the profit center's effective use of assets employed to earn a profit

Question # 4

In a fee-for-service (FFS) reimbursement method, providers are paid per treatment or per service that they provide. One typical benefit of FFS reimbursement is that it:

A.

Is highly effective in preventing excessive services that take the form of churning, unbundling, and upcoding

B.

Provides physicians who attempt to control costs with a higher rate of compensation than is provided to physicians who make the effort to control costs

C.

Is relatively easy to initiate, especially in markets where managed care penetration is low

D.

Guards against the practice of defensive medicine

Question # 5

A health plan may experience negative working capital whenever healthcare expenses generated by plan members exceed the premium income the health plan receives.

Ways in which a health plan can manage the volatility in claims payments, and therefore reduce the risk of negative working capital, include:

1. Accurately estimating incurred but not reported (IBNR) claims

2. Using capitation contracts for provider reimbursement

A.

Both 1 and 2

B.

1 only

C.

2 only

D.

Neither 1 nor 2