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AHM-510 PDF + Testing Engine



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  • Exam Name: Governance and Regulation
  • Last Update: 05-Jun-2023
  • Questions and Answers: 76
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AHM-510 Questions and Answers

Question # 1

After conducting a business portfolio analysis, the Acorn Health Plan decided to pursue a harvest strategy with one of its strategic business units (SBUs)-Guest Behavioral Healthcare. By following a harvest strategy with Guest, Acorn most likely is seeking to


Maximize Guest's short-term earnings and cash flow


Increase Guest's market share


Maintain Guest's market position


Sacrifice immediate earnings in order to fund Guest's growth

Question # 2

Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its provider network. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

With respect to the type of change that constitutes a material change under the HMO Model Act's disclosure requirements, the termination of one healthcare provider from Greenpath's provider network


Always qualifies as a material change in the plan, and Greenpath must report the change to all plan enrollees


Always qualifies as a material change in the plan, and Greenpath must report the change to only those plan enrollees who have received care from the terminated provider


Qualifies as a material change in the plan only if the provider is a primary care provider, and in such a case Greenpath must report the change to all plan enrollees


Qualifies as a material change in the plan only if the provider is a primary care provider, and in such a case Greenpath must report the change to only those plan enrollees who receive primary care from the terminated provider

Question # 3

SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detecting violations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.

By definition, the activity that SoundCare conducted when it examined its strengths, weaknesses, and capabilities is known as


An environmental analysis


An internal assessment


An environmental forecast


A community analysis

Question # 4

In the course of doing business, health plans conduct basic corporate transactions. For example, when a health plan engages in the corporate transaction known as aggressive sourcing, the health plan


Chooses to contract with vendors who provide specific functions that would otherwise be performed in-house, such as paying claims


Seeks to obtain the best deals from various vendors for equipment, supplies, and services such as telephones, overnight mail, computer hardware and software, and copy machines


Merges with one or more companies to form an entirely new company


Joins with one or more companies, but retains its autonomy and relies on the other companies to perform specific functions

Question # 5

Health plans typically divide their costs into medical and administrative expenses. Examples of medical expenses are.


Equipment costs


Salaries and benefits for executives and for all functional areas


Sales and marketing costs


Payments to providers for the delivery of healthcare

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