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  • Exam Name: Health Plan Finance and Risk Management
  • Last Update: 18-Apr-2024
  • Questions and Answers: 215
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AHM-520 Questions and Answers

Question # 1

Geena Falk is eligible for both Medicare and Medicaid coverage. If Ms. Falk incurs a covered expense, then:

A.

Medicaid will be Ms. Falk’s primary insurer

B.

Medicare will be Ms. Falk’s primary insurer

C.

Either Medicare or Medicaid will be Ms. Falk’s primary insurer depending on her election

D.

Medicare and Medicaid will each be responsible for one-half of Ms. Falk’s covered expense

Question # 2

Correct statements about the financial risks associated with benefits that health plans provide to the Medicare and Medicaid markets include:

A.

That, because the government sets the payments received by health plans, the health plans cannot easily obtain an increase in those payments even in the face of rising costs

B.

That regulators determine which services must be provided under Medicare and Medicaid and which persons are eligible to enroll in a plan

C.

That there is typically more provider reluctance to accept risk in connection with providing services to the Medicaid population than with providing services to the Medicare population

D.

All of the above

Question # 3

The Fairway health plan is a for-profit health plan that issues stock. The following data was taken from Fairway's financial statements:

Current assets.....$5,000,000

Total assets.....6,000,000

Current liabilities.....2,500,000

Total liabilities.....3,600,000

Stockholders' equity.....2,400,000

Fairway's total revenues for the previous financial period were $7,200,000, and its net income for that period was $180,000.

Assume that the healthcare industry average for the debt-to-equity ratio is 0.90. The following statement(s) can correctly be made about Fairway's debt to equity ratio:

A.

Fairway's debt-to-equity ratio is 1.50

B.

Fairway relies less than most other healthcare organizations on borrowed funds to cover future and current benefit payments, to pay for ongoing business operations, and to finance growth

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Question # 4

The following information relates to the Hardcastle Health Plan for the month of June:

  • Incurred claims (paid and IBNR) equal $100,000
  • Earned premiums equal $120,000
  • Paid claims, excluding IBNR, equal $80,000
  • Total health plan expenses equal $300,000

This information indicates that Hardcastle’s medical loss ratio (MLR) for the month of June was approximately equal to:

A.

40%

B.

67%

C.

83%

D.

120%

Question # 5

The following statements are about the capital budgeting technique known as the payback method. Select the answer choice containing the correct statement:

A.

The main benefit of the payback method is that it is simple to use.

B.

The payback method measures the profitability of a given capital project.

C.

The payback method considers the time value of money.

D.

The payback method states a proposed project’s cash flow in terms of present value for the life of the entire project.

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