AHIP Health Plan Finance and Risk Management - AHM-520무료 덤프문제 풀어보기
With regard to a health plan's underwriting of groups, it can correctly be stated that, generally, a
정답: D
When pricing its product, the Panda Health Plan assumes a 4% interest rate on its investments. Panda also assumes a crediting interest rate of 4%.
The actual interest rate earned by Panda on the assets supporting its product is 6%. The following statements can correctly be made about the investment margin and interest margin for Panda's products.
The actual interest rate earned by Panda on the assets supporting its product is 6%. The following statements can correctly be made about the investment margin and interest margin for Panda's products.
정답: B
Reconciliation is the process by which a health plan assesses providers' performance relative to contractual terms and reimbursement.
With regard to this process, it can correctly be stated that
With regard to this process, it can correctly be stated that
정답: B
The goals of Diane Tsai, the manager of the Oval Health Plan's accounting department, and the goals of Oval are mutually supportive. Oval's accounting department is able to establish and achieve the appropriate objectives, but the department's costs of operation are too high. The following statement(s) can correctly be made about this situation:
정답: A
A health plan may experience negative working capital whenever healthcare expenses generated by plan members exceed the premium income the health plan receives.
Ways in which a health plan can manage the volatility in claims payments, and therefore reduce the risk of negative working capital, include:
1.Accurately estimating incurred but not reported (IBNR) claims
2.Using capitation contracts for provider reimbursement
Ways in which a health plan can manage the volatility in claims payments, and therefore reduce the risk of negative working capital, include:
1.Accurately estimating incurred but not reported (IBNR) claims
2.Using capitation contracts for provider reimbursement
정답: D
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-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
정답: C
The Titanium health plan's product has a unit price of $120 PMPM and a unit variable cost of $80 PMPM. Titanium has $100,000 in fixed costs per month. This information indicates that, for its product, Titanium's
정답: B
The following statements are about a health plan's evaluation of its responsibility centers. Select the answer choice containing the correct statement.
정답: B
Dr. Jacob Winburne is compensated by the Honor Health Plan under an arrangement in which Honor establishes at the beginning of a financial period a fund from which claims approved for payment are paid. At the end of the given period, any funds remaining are
paid out to providers. This information indicates that the arrangement between Dr. Winburne and Honor includes a provider incentive known as a:
paid out to providers. This information indicates that the arrangement between Dr. Winburne and Honor includes a provider incentive known as a:
정답: B
With regard to the financial statements prepared by health plans, it can correctly be stated that
정답: B
Variance analysis is the study of the difference between expected results and actual results. Variances can be positive or negative. A positive variance is typically considered:
정답: D