Free AHIP AHM-520 Exam Questions
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AHIP AHM-520 Exam Questions
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Provided By: AHIP
- Exam: Health Plan Finance and Risk Management (AHM520)
- Certification: AHIP Certification
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Total Questions: 215
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Updated On: Jun 05, 2025
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Rated: 4.9 |
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Online Users: 430
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Question 1
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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:
Answer: C
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The Marble Health Plan sets aside a PMPM amount for each specialty.
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Question 2
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The Jasmine Company, which self-funds the health plan for its 200 employees, has established a 501(c)(9) trust as a means of addressing possible claims fluctuations under the health plan. This plan is not a part of a collective bargaining process.
A potential disadvantage to Jasmine of using a 501(c)(9) trust is that:
Answer: A
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The Jasmine Company, which self-funds the health plan for its 200 employees, has established a 501(c)(9) trust as a means of addressing possible claims fluctuations under the health plan. This plan is not a part of a collective bargaining process.
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Question 3
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Users of the Fulcrum Health Plan financial information include:
The independent auditors who review Fulcrum's financial statements
Fulcrum's controller (comptroller)
Fulcrum's plan members -
The providers that deliver healthcare services to Fulcrum plan members
Fulcrum's competitors -
Of these users, the ones that most likely can correctly be classified as external users with a direct financial interest in Fulcrum are the:
Answer: D
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Users of the Fulcrum Health Plan financial information include:
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Question 4
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The Jasmine Company, which self-funds the health plan for its 200 employees, has established a 501(c)(9) trust as a means of addressing possible claims fluctuations under the health plan. This plan is not a part of a collective bargaining process.
A potential disadvantage to Jasmine of using a 501(c)(9) trust is that:
Answer: A
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The Jasmine Company, which self-funds the health plan for its 200 employees, has established a 501(c)(9) trust as a means of addressing possible claims fluctuations under the health plan. This plan is not a part of a collective bargaining process.
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Question 5
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The Atoll Health Plan must comply with a number of laws that directly affect the plan's contracts. One of these laws allows Atoll's plan members to receive medical services from certain specialists without first being referred to those specialists by a primary care provider (PCP). This law, which reduces the PCP's ability to manage utilization of these specialists, is known as _________.
Answer: C
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The Atoll Health Plan must comply with a number of laws that directly affect the plan's contracts. One of these laws allows Atoll's plan members to receive medical services from certain specialists without first being referred to those specialists by a primary care provider (PCP). This law, which reduces the PCP's ability to manage utilization of these specialists, is known as _________.