Free AHM-520 Exam Braindumps

- (Topic 1)
The Newfeld Hospital has contracted with the Azalea Health Plan to provide inpatient services to Azalea's enrolled members. The contract calls for Azalea to provide specific stop-loss coverage to Newfeld once Newfeld's treatment costs reach $20,000 per case and for Newfeld to pay 20% of the next $50,000 of expenses for this case. After Newfeld's treatment costs on a case reach $70,000, Azalea reimburses the hospital for all subsequent treatment costs.
The maximum amount for which Newfeld is at risk for any one Azalea plan member's treatment costs is

1. A. $10,000
2. B. $14,000
3. C. $30,000
4. D. $34,000

Correct Answer: C

- (Topic 2)
In evaluating the claims experience during a given rating period of the Lucky Company, the Calaway Health Plan determined that the claims incurred by Lucky were lower than Calaway anticipated when it established Lucky’s premium rate for the rating period. Calaway, therefore,refunded a portion of Lucky’s premium to reflect the better-than- anticipated claims experience. This rating method is known as:

1. A. durational rating
2. B. retrospective experience rating
3. C. blended rating
4. D. prospective experience rating

Correct Answer: B

- (Topic 1)
The Fiesta Health Plan prices its products in such a way that the rates for its products are reasonable, adequate, equitable, and competitive. Fiesta is using blended rating to calculate a premium rate for the Murdock Company, a large employer. Fiesta has assigned a credibility factor of 0.6 to Murdock. Fiesta has also determined that Murdock's manual rate is $200 PMPM and that Murdock's experience rate is $180 PMPM. Fiesta would correctly calculate that its blended rate PMPM for Murdock should be Fiesta's retention charge plus

1. A. $152
2. B. $188
3. C. $192
4. D. $228

Correct Answer: B

- (Topic 2)
With regard to alternative funding arrangements, the part of a health plan premium that is intended to contribute to the claims reserve that a health plan maintains to pay for unusually high utilization is known as the:

1. A. Interest charge
2. B. Retention charge
3. C. Risk charge
4. D. Surplus

Correct Answer: C

- (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