Most Recent AHIP AHM-520 Exam Questions & Answers

Prepare for the AHIP Health Plan Finance and Risk Management exam with our extensive collection of questions and answers. These practice Q&A are updated according to the latest syllabus, providing you with the tools needed to review and test your knowledge.

QA4Exam focus on the latest syllabus and exam objectives, our practice Q&A are designed to help you identify key topics and solidify your understanding. By focusing on the core curriculum, These Questions & Answers helps you cover all the essential topics, ensuring you're well-prepared for every section of the exam. Each question comes with a detailed explanation, offering valuable insights and helping you to learn from your mistakes. Whether you're looking to assess your progress or dive deeper into complex topics, our updated Q&A will provide the support you need to confidently approach the AHIP AHM-520 exam and achieve success.

The questions for AHM-520 were last updated on Dec 20, 2024.

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Question No. 1

A health plan can use a SWOT (strengths, weaknesses, opportunities, and threats) analysis to analyze its relationships with the major providers in each market in which it conducts business.

ATrue

BFalse

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Correct Answer: A

Question No. 2

The HMO Model Act sets certain requirements that an entity that wishes to operate as an HMO must meet. These requirements include:

AHaving an initial net worth of at least $5 million

BMaintaining a net worth equal to at least 5% of premium revenues for the first $150 million in premium revenue

CUsing a prospective method to estimate future risk

DObtaining a certificate of authority (COA) before beginning operations

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Correct Answer: D

Question No. 3

One true statement about capital and surplus ratios for health plans is that

AThis ratio is calculated by dividing a health plan's total liabilities by its capital and surplus

BA health plan's capital and surplus position would be likely to weaken because of reserve valuation changes that reduce the health plan's reserves

CThe primary purpose of these ratios is to compare a health plan's obligations to its ability to meet those obligations

DAn increase in the value of a health plan's capital and surplus ratio most likely indicates that the health plan's financial position has strengthened

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Correct Answer: D

Question No. 4

The Violin Company offers its employees a triple option of health plans: an HMO, an HMO with a point of service (POS) option, and an indemnity plan.

Premiums are lowest for the HMO option and highest for the indemnity plan. Violin employees who anticipate that they will be individual low utilizes of healthcare services are most likely to enroll in the

AHMO and are least likely to enroll in the HMO with the POS option

BHMO and are least likely to enroll in the indemnity plan

CIndemnity plan and are least likely to enroll in the HMO

DIndemnity plan and are least likely to enroll in the HMO with the POS option

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Correct Answer: B

Question No. 5

Rasheed Azari, the risk manager for the Tower health plan, is attempting to work with providers in the organization in order to reduce the providers' exposure related to utilization review. Mr. Azari is considering advising the providers to take the following actions:

1-Allow Tower's utilization management decisions to override a physician's independent medical judgment

2-Support the development of a system that can quickly render a second opinion in case of disagreement surrounding clinical judgment

3-Inform a patient of any issues that are being disputed relative to a physician's recommended treatment plan and Tower's coverage decision

Of these possible actions, the ones that are likely to reduce physicians' exposures related to utilization review include actions

A1, 2, and 3

B1 and 2 only

C1 and 3 only

D2 and 3 only

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Correct Answer: D

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