AHM-520 Free Practice Test

- (Topic 2)
Cascade Hospital has negotiated with the McBee Health Plan a straight per-diem rate of $1,000 per day for medical admissions. One of McBee’s plan members was admitted to Cascade for 10 days. Total billed charges equaled $10,000, of which $2,000 were for noncovered items. This information indicates that, for this admission, the amount that McBee was obligated to reimburse Cascade was:

1. A. $0
2. B. $8,000
3. C. $10,000
4. D. $12,000

Correct Answer: C

- (Topic 2)
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. A. global fee
2. B. relative value scale
3. C. unbundling
4. D. discounted fee-for-service

Correct Answer: A

- (Topic 2)
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:

1. 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.
2. B. A small group must consist of more than 10 employees in order to be underwritten on a group, rather than an individual, basis.
3. C. A health plan is prohibited from canceling a small group’s healthcare coverage because of poor claims experience.
4. 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.

Correct Answer: B

- (Topic 1)
The Lighthouse health plan operates in a state that allows the health plan to use an underwriting method of determining a group's premium in which underwriters treat several small groups as one large group for risk assessment purposes. This method, which helps Lighthouse more accurately estimate a small group's probable claims costs, is known as

1. A. Case stripping
2. B. The low-option rating method
3. C. The rate spread method
4. D. Pooling

Correct Answer: D

- (Topic 1)
If the Ascot health plan's accountants follow the going-concern concept under GAAP, then these accountants most likely

1. A. Assume that Ascot will pay its liabilities immediately or in full during the current accounting period
2. B. Defer certain costs that Ascot has incurred, unless these costs contribute to the healthplan's future earnings
3. C. Assume that Ascot is not about to be liquidated, unless there is evidence to the contrary
4. D. Value Ascot's assets more conservatively than they would under SAP

Correct Answer: C