Question 1

Under GAAP, three approaches to expense recognition are generally allowed: associating cause and effect, systematic and rational allocation, and immediate recognition.

A health plan most likely would use the approach of systematic and rational allocation in order to:

Options :

A : Report the payment of the health plan-s utility bills

B : Spread the payment of sales force commissions over the premium paying period of healthcare coverage

C : Report the fees paid by the health plan to attorneys and consultants

D : Depreciate the cost of a new computer system over the useful life of the system

Answer: D

Question 2

The Marble Health Plan sets aside a PMPM amount for each specialty.

When a PCP in Marble's provider network refers a Marble plan member to a specialist and the specialist provides medical services to the member, the specialist begins to receive a share of those funds on a monthly basis. Marble determines the monthly payment for each specialist by dividing the number of active patients for that specialty by the total specialty pool for that month.

This form of payment, which is similar to a case rate, is known as:

Options :

A : Referral circle capitation

B : Risk pod capitation

C : Contact capitation

D : Retrospective reimbursement capitation

Answer: C

Question 3

The following statements are about the Health Insurance Portability and Accountability Act (HIPAA) as it relates to the small group market. Three of these statements are true and one statement is false. Select the answer choice containing the FALSE statement.

Options :

A : A health plan that participates in the small group market is required to issue a contract to any employer that requests healthcare benefits, as long as the employer meets the statutory definition of a small group.

B : A small group must consist of more than 10 employees in order to be underwritten on a group, rather than an individual, basis.

C : A health plan is prohibited from canceling a small group’s healthcare coverage because of poor claims experience.

D : A health plan that participates in the small group market is limited in placing restrictions such as waiting periods and pre-existing conditions exclusions to individuals in high risk categories.

Answer: B

Question 4

Julio Benini is eligible to receive healthcare coverage through a health plan that is under contract to his employer. Mr. Benini is seeking coverage for the following individuals:

Elena Benini, his wife -

Maria Benini, his 18-year-old unmarried daughter

Johann Benini, his 80-year-old father who relies on Julio for support and maintenance

The health plan most likely would consider that the definition of a dependent, for purposes of healthcare coverage, applies to:

Options :

A : Elena, Maria, and Johann

B : Elena and Maria only

C : Elena only

D : Maria only

Answer: B

Question 5

In order to determine a health plan's quick liquidity ratio, a financial analyst would divide the health plan's:

Options :

A : Total assets not invested in affiliates by its total liabilities

B : Liquid assets by its total liabilities

C : Liquid assets by its contractual reserves

D : Total assets by its contractual reserves

Answer: C

Smartly Prepare Exam with Free Online AHM-520 Practice Test

Buying Options: