AHM-520 Exam Dumps - AHIP Certification Questions and Answers

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Questions 4

The HMO Model Act sets certain requirements that an entity that wishes to operate as an HMO must meet. These requirements include:

Options:

Having an initial net worth of at least $5 million

Maintaining a net worth equal to at least 5% of premium revenues for the first $150 million in premium revenue

Using a prospective method to estimate future risk

Obtaining a certificate of authority (COA) before beginning operations

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Questions 5

The following statements are about the new methodology authorized under the Balanced Budget Act of 1997 (BBA) for payments by the Centers for Medicaid & Medicare Services (CMS) to Medicare-contracting health plans.

Select the answer choice containing the correct statement.

Options:

Under this new methodology, Medicare-contracting health plans are paid the lower of (a) a floor payment amount per enrollee covered or (b) the health plan's payment rate increased by 2% from the previous year.

The new methodology has decreased the rate of growth in payments from CMS to Medicare-contracting health plans.

Under this new methodology, Medicare-contracting health plans are paid 90% of the adjusted average per capita cost (AAPCC) of providing a service to a beneficiary.

Under the principal inpatient diagnostic cost group (PIP-DCG), a new risk adjustment methodology, Medicare-contracting health plans will no longer be required to calculate and submit to CMS a Medicare adjusted community rate (ACR).

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Questions 6

The Violin Company offers its employees a triple option of health plans: an HMO, an HMO with a point of service (POS) option, and an indemnity plan.

Premiums are lowest for the HMO option and highest for the indemnity plan. Violin employees who anticipate that they will be individual low utilizes of healthcare services are most likely to enroll in the

Options:

HMO and are least likely to enroll in the HMO with the POS option

HMO and are least likely to enroll in the indemnity plan

Indemnity plan and are least likely to enroll in the HMO

Indemnity plan and are least likely to enroll in the HMO with the POS option

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Questions 7

Under the alternative funding method used by the Trilogy Company, the insurer charges Trilogy an initial premium that is based on the assumption that claims will be 93% of the expected claims for the year. If claims exceed 93% of expected claims, then Trilogy must reimburse the insurer for any additional claims paid, up to 112% of expected claims. The insurer bears the responsibility for paying claims in excess of 112% of expected claims.

From the following answer choices, choose the name of the alternative funding method described.