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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 following statements are about the financial risks for health plans in Medicare and Medicaid markets. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

Options:

A.

One reason that health plans in the Medicare and Medicaid markets experience financial risk is that government regulations determine which services must be provided to Medicare and Medicaid enrollees.

B.

Effective use of hospital utilization is the single most likely factor to contribute to the success of a Medicare-contracting health plan.

C.

If a Medicare-contracting health plan is a provider-sponsored organization (PSO), it is prohibited from sharing financial risk with its providers.

D.

Typically, providers are more reluctant to accept financial risk in connection with providing services to the Medicaid population than with providing services to the Medicare population.

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Question 2

One true statement about cash-basis accounting is that

Options:

A.

Cash receipt, but not cash disbursement, is an important component of cash-basis accounting

B.

Most companies use a pure cash-basis accounting system

C.

Cash-basis accounting records revenue according to the realization principle and expenses according to the matching principle

D.

Health insurance companies and health plans that fall under the jurisdiction of state insurance commissioners must report some items on a cash basis for statutory reporting purposes

Question 3

The types of financial risks and costs to which a health plan is subject depends on whether the health plan provides services to the Medicare and/or Medicaid populations or to the commercial population. One distinction between providing services to the Medicare and Medicaid populations and to the commercial population is that Medicare and Medicaid enrollees typically:

Options:

A.

Are locked into a plan for a 12-month period, whereas enrollees from the commercial population may disenroll from a plan on a monthly basis

B.

Require less enrollee education than do enrollees from the commercial population

C.

Have higher incidences of chronic illness than do enrollees from the commercial population

D.

Are enrolled in a health plan through a group situation, whereas the commercial population typically enrolls in a health plan on an individual basis