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AHM-520 Exam Dumps : Health Plan Finance and Risk Management

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Health Plan Finance and Risk Management Questions and Answers

Question 1

The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures:

  • Preferred provider organization (PPO)
  • Group model HMO
  • Staff model health maintenance organization (HMO)
  • Traditional health insurance

Of these health plan products, the one that would most likely expose a health plan to the highest risk is the:

Options:

A.

preferred provider organization (PPO)

B.

group model HMO

C.

staff model health maintenance organization (HMO)

D.

traditional health insurance

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Question 2

All publicly traded health plans in the United States are required to prepare financial statements for use by their external users in accordance with generally accepted accounting principles (GAAP). In addition, health insurers and health plans that fall under the jurisdiction of state insurance departments are required by law to prepare certain financial statements in accordance with statutory accounting practices (SAP). In a comparison of GAAP to SAP, it is correct to say that:

Options:

A.

GAAP is established and promoted by the National Association of Insurance Commissioners (NAIC), whereas SAP is established and promoted by the Financial Accounting Standards Board (FASB)

B.

The going-concern concept is an underlying premise of GAAP, whereas SAP tends to focus on the liquidation value of the MCO or the insurer

C.

GAAP provides for a single method of valuing all of a health plan’s assets, whereas SAP offers the health plan more than one method for valuing its assets

D.

The principle of conservatism is fundamental to GAAP, whereas SAP generally is not conservative in nature

Question 3

Geena Falk is eligible for both Medicare and Medicaid coverage. If Ms. Falk incurs a covered expense, then:

Options:

A.

Medicaid will be Ms. Falk’s primary insurer

B.

Medicare will be Ms. Falk’s primary insurer

C.

Either Medicare or Medicaid will be Ms. Falk’s primary insurer depending on her election

D.

Medicare and Medicaid will each be responsible for one-half of Ms. Falk’s covered expense