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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

A health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

Options:

A.

True

B.

False

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Question 2

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

Question 3

A stop-loss contract may provide that claims are settled using a paid claims method or an incurred claims method. The Concord Company provides health coverage to its employees through a self-funded health plan. On March 17, a Concord employee who is enrolled in this plan underwent surgery, and the surgery was sufficiently expensive to trigger Concord's specific stop-loss coverage. On April 10, Concord paid the medical expenses associated with the surgery. The term of the stop-loss contract ended on April 1. This information indicates that the stop-loss carrier is responsible for paying a portion of the cost of the surgery under

Options:

A.

both the paid claims method and the incurred claims method

B.

the paid claims method but not the incurred claims method

C.

the incurred claims method but not the paid claims method

D.

neither the paid claims method nor the incurred claims method