AHM-520 Free Practice Test

- (Topic 1)
The Caribou health plan is a for-profit organization. The financial statements that Caribou prepares include balance sheets, income statements, and cash flow statements. To prepare its cash flow statement, Caribou begins with the net income figure as reported on its income statement and then reconciles this amount to operating cash flows through a series of adjustments. Changes in Caribou's cash flow occur as a result of the health plan's operating activities, investing activities, and financing activities.
To prepare its cash flow statement, Caribou uses the direct method rather than the indirect method.

1. A. True
2. B. False

Correct Answer: B

- (Topic 2)
A health plan can use a SWOT (strengths, weaknesses, opportunities, and threats) analysis to analyze its relationships with the major providers in each market in which it conducts business.

1. A. True
2. B. False

Correct Answer: A

- (Topic 2)
The Raven Health Plan is domiciled in a state that requires the health plan to offer small employers and their employees a comprehensive healthcare benefit plan that approximates the healthcare benefits available to large employer-employee groups. This type of uniform benefit plan is known as:

1. A. A basic plan
2. B. A low-option plan
3. C. A standard plan
4. D. An essential plan

Correct Answer: C

- (Topic 2)
Many clinicians are concerned about the development of practice guidelines that seek to define appropriate healthcare services that should be provided to a patient who has been diagnosed with a specific condition. To avoid the risk associated with using such guidelines, health plans should advise clinicians that the existence of such a guideline:
* 1. Establishes standards of care to be routinely utilized with all patients presenting a specific condition
* 2. Preempts a physician’s judgment when assessing the specific factors related to a patient’s condition

1. A. Both 1 and 2
2. B. 1 only
3. C. 2 only
4. D. Neither 1 nor 2

Correct Answer: D

- (Topic 1)
The physicians who work for the Sunrise Health Plan, a staff model HMO, are paid a salary that is not augmented with another type of incentive plan. Compared to the use of a traditional reimbursement method, Sunrise's use of a salary reimbursement method is more likely to

1. A. Encourage Sunrise's physicians to perform services that are not medically necessary
2. B. Completely eliminate service risk for Sunrise's physicians
3. C. Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers
4. D. Help stabilize expenses for Sunrise

Correct Answer: D