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Exam Code: AHM-520
Exam Name: Health Plan Finance and Risk Management
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AHM-520 Exam Questions Total Q&A: 215 Questions and Answers
Last Update: 2015-08-08

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Exam Code: AHM-530
Exam Name: Network Management
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NO.1 The following information was presented on one of the financial statements prepared by the
Rouge health plan as of December 31, 1998:
When calculating its cash-to-claims payable ratio, Rouge would correctly divide its:
A. Cash by its reported claims only
B. Cash by its reported claims and its incurred but not reported claims (IBNR)
C. Reported claims by its cash
D. Reported claims and its incurred but not reported claims (IBNR) by its cash
Answer: B

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NO.2 The sentence below contains two pairs of words enclosed in parentheses. Determine which
word in each pair correctly completes the statement. Then select the answer choice containing the
two words that you have chosen. Purchasing stop-loss coverage most likely (increases / reduces) a
health plan's underwriting risk and (increases / reduces) the health plan's affiliate risk.
A. increases / increases
B. increases / reduces
C. reduces / increases
D. reduces / reduces
Answer: C

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NO.3 The Caribou health plan is a for-profit organization. The financial statements that Caribou
prepares include balance sheets, income statements, and cash flow statements. To prepare its cash
flow statement, Caribou begins with the net income figure as reported on its income statement and
then reconciles this amount to operating cash flows through a series of adjustments. Changes in
Caribou's cash flow occur as a result of the health plan's operating activities, investing activities, and
financing activities.
The main purpose of Caribou's balance sheet is to
A. Reveal how Caribou obtained particular assets or liabilities
B. Show how much money Caribou has realized from its operations during an accounting period
C. Measure the owners' wealth
D. Reconcile the cash that Caribou has on hand at the beginning and at the end of an accounting
period
Answer: C

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NO.4 The provider contract that Dr. Timothy Meyer, a pediatrician, has with the Cardigan health
plan states that Cardigan will compensate him under a capitation arrangement. However, the
contract also includes a typical low enrollment guarantee provision. Statements that can correctly be
made about this arrangement include that the low enrollment guarantee provision most likely:
A. Causes Dr. Meyer's capitation contract with Cardigan to transfer more risk to him than the
contract otherwise would transfer
B. Specifies that Cardigan will pay Dr. Meyer under an arrangement other than capitation until a
specified number of children covered by the plan use him as their PCP
C. Both A and B
D. A only
E. B only
F. Neither A nor B
Answer: C

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NO.5 The Lindberg Company has decided to terminate its group healthcare coverage with the Benson
Health Plan. Lindberg has several former employees who previously experienced qualifying events
that caused them to lose their group coverage. One federal law allows these former employees to
continue their group healthcare coverage. From the answer choices below, select the response that
correctly identifies the federal law that grants these individuals with the right to continue group
healthcare coverage, as well as the entity which is responsible for continuing this coverage:
A. Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Lindberg
B. Federal law: Consolidated Omnibus Budget Reconciliation Act (COBRA) Entity: Benson
C. Federal law: Employee Retirement Income Security Act (ERISA) Entity: Lindberg
D. Federal law: Employee Retirement Income Security Act (ERISA) Entity: Benson
Answer: A

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NO.6 One true statement about cash-basis accounting is that
A. Cash receipt, but not cash disbursement, is an important component of cash-basis accounting
B. Most companies use a pure cash-basis accounting system
C. Cash-basis accounting records revenue according to the realization principle and expenses
according to the matching principle
D. Health insurance companies and health plans that fall under the jurisdiction of state insurance
commissioners must report some items on a cash basis for statutory reporting purposes
Answer: D

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NO.7 An investor deposited $1,000 in an interest-bearing account today. That sum will accumulate to
$1,200 two years from now. One true statement about this transaction is that:
A. The process by which the original $1,000 deposit grows to $1,200 is known as compounding
B. $1,200 is the present value of the $1,000 deposit
C. The $200 increase in the deposit's value is its incremental cash flow
D. The $200 difference between the original deposit and the accumulated value of the deposit is
known as the deposit's discount
Answer: A

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NO.8 Federal law addresses the relationship between Medicare- or Medicaidcontracting health plans
and providers who are at "substantial financial risk."
Under federal law, Medicare- or Medicaid-contracting health plans
A. Place a provider at "substantial risk" whenever incentive arrangements put the provider at risk for
amounts in excess of 10% of his or her total potential reimbursement for providing services to
Medicare and Medicaid enrollees
B. Must provide stop-loss coverage to a provider who is placed at "substantial financial risk" for
services that the provider does not directly provide to Medicare or Medicaid enrollees
C. Both A and B
D. A only
E. B only
F. Neither A nor B
Answer: C

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