Online Access Free AHM-520 Exam Questions

The following statements are about carve-out programs. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

• A.The most rapidly growing area related to carve-outs is disease management (DM).
• B.Carve-outs are services that are excluded from a capitation payment, a risk pool, or a health benefit plan.
• C.In the type of carve-out in which entire categories of care are administered by independent organizations, a health plan typically reimburses these organizations under an FFS contract.
• D.Typically, a health plan will offer carved-out services to its enrollees, but will manage these services separately.

Under the doctrine of corporate negligence, a health plan and its physician administrators may be held directly liable to patients or providers for failing to investigate adequately the competence of healthcare providers whom it employs or with whom it contracts, particularly where the health plan actually provides healthcare services or restricts the patient's/enrollee's choice of physician.

• A.False
• B.True

A health plan can use cost accounting in order to

• A.Both A and B
• B.Neither A nor B
• C.A only
• D.Determine premium rates for its products
• E.Match the costs incurred during a given accounting period to the income earned in, or attributed to, that same period
• F.B only

The Rathbone Company has contracted with the Jarvin Insurance Company to provide healthcare benefits to its employees. Under this contract, Rathbone assumes financial responsibility for paying 80% of its estimated annual claims and for depositing the funds necessary to pay these claims into a bank account. Although Rathbone owns the bank account, Jarvin, acting as Rathbone's agent, makes the actual claims payments from this account. Claims in excess of Rathbone's contracted percentage are paid by Jarvin. Rathbone pays to Jarvin a premium for administering the entire plan and bearing the costs of claims in excess of Rathbone's obligation. This premium is substantially lower than would be charged if Jarvin were providing healthcare coverage under a traditional fully insured group plan. Jarvin is required to pay premium taxesonly on the premiums it receives from Rathbone. This information indicates that the type of alternative funding method used by Rathbone is known as a:

• A.Retrospective-rating arrangement
• B.Minimum-premium plan
• C.Premium-delay arrangement
• D.Reserve-reduction arrangement

As part of the first step in its strategic planning process, the Trout health plan developed the following statements:
- Statement A-Trout will deliver quality healthcare to our customers at a reasonable cost. - Statement B-Within five years, Trout will be recognized as the industry leader in all of our markets.
Statement A can best be described as a

• A.Mission statement, and Statement B also can best be described as a mission statement
• B.Mission statement, whereas Statement B can best be described as a vision statement
• C.Vision statement, and Statement B also can best be described as a vision statement
• D.Vision statement, whereas Statement B can best be described as a mission statement