Health Plan Finance and Risk Management (AHM-520) - AHIP Exam Questions

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:

The provider contract that Dr. Timothy Meyer, a pediatrician, has with the Cardigan health plan states that Cardigan will compensate him under a capitation arrangement. However, the contract also includes a typical low enrollment guarantee provision. Statements that can correctly be made about this arrangement include that the low enrollment guarantee provision most likely: A Causes Dr. Meyer's capitation contract with Cardigan to transfer more risk to him than the contract otherwise would transfer

The following examples describe situations that expose an individual or a health plan to either pure risk or speculative risk:
Example 1 — A health plan invested in 1,000 shares of stock issued by a technology company.
Example 2 — An individual could contract a terminal illness. Example 3 — A health plan purchased a new information system. Example 4 — A health plan could be held liable for the negligent acts of an employee. The examples that describe pure risk are

Health plans with risk-based Medicare contracts are required to calculate and submit to CMS a

Medicare adjusted community rate (Medicare ACR). Medicare ACR can be defined as the:

In the following paragraph, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have selected. Budgeting approaches can be classified as static or flexible budgets, or as rolling or period budgets. A health plan most likely would use a (static / flexible) budget when a budget's objective is to reduce or limit expenses, and the health plan most likely would use a (rolling / period) budget if it would like to continually maintain projections for a certain time period into the future.