AHM-520 practice questions, page 7 of 9, with answer review and explanations.
Question 31
Rasheed Azari, the risk manager for the Tower health plan, is attempting to work with providers in the organization in order to reduce the providers' exposure related to utilization review. Mr. Azari is considering advising the providers to take the following actions: 1. Allow Tower's utilization management decisions to override a physician's independent medical judgment 2. Support the development of a system that can quickly render a second opinion in case of disagreement surrounding clinical judgment 3. Inform a patient of any issues that are being disputed relative to a physician's recommended treatment plan and Tower's coverage decision Of these possible actions, the ones that are likely to reduce physicians' exposures related to utilization review include actions:
1, 2, and 3
1 and 2 only
1 and 3 only
2 and 3 only
Question 32
In order to determine a health plan's quick liquidity ratio, a financial analyst would divide the health plan's:
Total assets not invested in affiliates by its total liabilities
Liquid assets by its total liabilities
Liquid assets by its contractual reserves
Total assets by its contractual reserves
Question 33
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:
Estimated cost of providing services to a beneficiary under Medicare FFS, adjusted for factors such as age and gender
Health plan’s estimate of the premium it would charge Medicare enrollees in the absence of Medicare payments to the health plan
Average amount the health plan expects to receive from CMS per beneficiary covered
Health plan’s actual costs of providing benefits to Medicare enrollees in a given year
Question 34
The following statements are about the capital budgeting technique known as the payback method. Select the answer choice containing the correct statement:
The main benefit of the payback method is that it is simple to use.
The payback method measures the profitability of a given capital project.
The payback method considers the time value of money.
The payback method states a proposed project’s cash flow in terms of present value for the life of the entire project.
Question 35
Under the alternative funding method used by the Trilogy Company, the insurer charges Trilogy an initial premium that is based on the assumption that claims will be 93% of the expected claims for the year. If claims exceed 93% of expected claims, then Trilogy must reimburse the insurer for any additional claims paid, up to 112% of expected claims. The insurer bears the responsibility for paying claims in excess of 112% of expected claims. From the following answer choices, choose the name of the alternative funding method described.