AHM-520

AHM-520 practice questions, page 8 of 9, with answer review and explanations.

Question 36

With regard to the major risk factors associated with group underwriting, it can correctly be stated that, typically:

  1. The age and gender of group plan members are not predictors of utilization of health services by group members
  2. A health plan's product design or delivery system has an impact on member selection of the health plan, unless the members are in an environment in which employees have at least two benefit options or health plans from which to choose
  3. A health plan should track demographic factors of groups only if the plan specifically adjusts for demographic factors on a group basis
  4. A large group is more likely to exhibit a consistent claims pattern, level of healthcare cost, or utilization of services than is a small group

Question 37

The Fairway health plan is a for-profit health plan that issues stock. The following data was taken from Fairway's financial statements: Current assets.....$5,000,000 - Total assets.....$6,000,000 - Current liabilities.....$2,500,000 Total liabilities.....$3,600,000 Stockholders' equity.....$2,400,000 Fairway's total revenues for the previous financial period were $7,200,000, and its net income for that period was $180,000. From this data, Fairway can determine both its current ratio and its net working capital. Fairway would correctly determine that its:

  1. Current ratio is 1.39
  2. Current ratio is 2.00
  3. Net working capital equals $1,000,000
  4. Net working capital equals $3,000,000

Question 38

The theory of vicarious liability or ostensible agency can expose a health plan to the risk that it could be held liable for the acts of independent contractors. Factors that may give rise to the assumption that an agency relationship exists between a health plan and its independent contractors include:

  1. Requiring the providers to supply their own office space
  2. Employing nurses and other healthcare professionals to support the physician providers
  3. Requiring providers to maintain their own medical records
  4. All of the above

Question 39

Dr. Martin Cassini is an obstetrician who is under contract with the Bellerby Health Plan. Bellerby compensates Dr. Cassini for each obstetrical patient he sees in the form of a single amount that covers the costs of prenatal visits, the delivery itself, and post-delivery care. This information indicates that Dr. Cassini is compensated under the provider reimbursement method known as a:

  1. global fee
  2. relative value scale
  3. unbundling
  4. discounted fee-for-service

Question 40

In order to analyze costs for internal management purposes, the Banner health plan uses functional cost analysis. One characteristic of this method of cost analysis is that it:

  1. Enables Banner's top management to analyze costs as they apply to workflow rather than to organizational structures
  2. Assumes that activities, not products, generate costs
  3. Cannot be used when Banner makes pricing and staffing decisions
  4. Identifies units of activity, calculates the costs of performing each unit of activity, and then assigns the cost of each unit of activity to Banner's products or lines of business