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

Last updated on June 20, 2026

97% Exam Compliance
215 Total Questions
1
Question
The Acorn Health Plan uses a resource-based relative value scale (RBRVS) to help determine the reimbursement amounts that Acorn should make to providers who are compensated under an FFS system. With regard to the advantages and disadvantages to Acorn of using RBRVS, it can correctly be stated that
Options
A An advantage of using RBRVS is that it puts providers who render more medical services than necessary at financial risk for this overutilization
B A disadvantage of using RBRVS is that it rewards procedural healthcare services more than cognitive healthcare services
C An advantage of using RBRVS is that it can assist Acorn in developing reimbursement schedules for various types of providers in a comprehensive healthcare plan
D A disadvantage of using RBRVS is that it will be difficult for Acorn to track treatment rates for the health plan's quality and cost management functions
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2
Question
The following information relates to the Hardcastle Health Plan for the month of June:
Incurred claims (paid and IBNR) equal $100,000
Earned premiums equal $120,000
Paid claims, excluding IBNR, equal $80,000
Total health plan expenses equal $300,000
This information indicates that Hardcastle’s medical loss ratio (MLR) for the month of June was approximately equal to:
Options
A 83%
B 67%
C 40%
D 120%
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3
Question
One way that a health plan can protect itself against case stripping is by requiring:
Options
A The small group to have no more than 10 members
B Its underwriters to consider the characteristics of the employer, but not of the group members,
when underwriting the group
C Employees covered by a small group plan to contribute 100% of the cost of the healthcare
coverage
D A minimum level of participation in order for a small group to be eligible for healthcare coverage
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4
Question
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
Options
A A only
B B only
C Both A and B
D Neither A nor B
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5
Question
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:
Options
A Health plan’s estimate of the premium it would charge Medicare enrollees in the absence of Medicare payments to the health plan
B Health plan’s actual costs of providing benefits to Medicare enrollees in a given year
C Estimated cost of providing services to a beneficiary under Medicare FFS, adjusted for factors such as age and gender
D Average amount the health plan expects to receive from CMS per beneficiary covered
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