AHIP AHM-520 問題集

質問 1：
The Atoll Health Plan must comply with a number of laws that directly affect the plan's contracts. One of these laws allows Atoll's plan members to receive medical services from certain specialists without first being referred to those specialists by a primary care provider (PCP). This law, which reduces the PCP's ability to manage utilization of these specialists, is known as _________.
A. A fair procedure law
B. A direct access law
C. A due process law
D. An any willing provider law
正解：B

質問 2：
For this question, select the answer choice containing the terms that correctly complete blanks A and B in the paragraph below. The FASB mandates that accounting information must exhibit certain qualitative characteristics. One of these characteristics is ________A________, which means that a company's financial statements use the same accounting policies and procedures from one accounting period to the next, unless there is a sound reason for changing a policy or procedure. Another characteristic is _________B________, which requires a company to disclose in its financial statements all significant financial information about the company.
A. A = consistency B = comparability
B. A = reliability B = materiality
C. A = consistency B = materiality
D. A = reliability B = comparability
正解：C

質問 3：
The Marble Health Plan sets aside a PMPM amount for each specialty.
When a PCP in Marble's provider network refers a Marble plan member to a specialist and the specialist provides medical services to the member, the specialist begins to receive a share of those funds on a monthly basis. Marble determines the monthly payment for each specialist by dividing the number of active patients for that specialty by the total specialty pool for that month.
This form of payment, which is similar to a case rate, is known as
A. Contact capitation
B. Retrospective reimbursement capitation
C. Referral circle capitation
D. Risk pod capitation
正解：A

質問 4：
The Sanford Group, a provider group, entered into a risk contract with a health plan. Sanford has purchased aggregate stop-loss coverage with an attachment point of 115% of the group's predicted healthcare costs of $2,000,000 for the year. Sanford has a copayment of 10% for any costs above the attachment point. If Sanford's actual costs for the year are $2,800,000, then, according to the terms of the aggregate stop-loss agreement, the amount that Sanford is responsible for is
A. $2,350,000
B. $2,380,000
C. $2,300,000
D. $2,080,000
正解：A

質問 5：
The following statements indicate the pricing policies of two health plans that operate in a particular market:
- The Accent Health Plan consistently underprices its product - The Bolton Health Plan uses extremely strict underwriting practices for the small groups to which it markets its plan
From the following answer choices, select the response that correctly indicates the most likely market effects of the pricing policies used by Accent and Bolton.
A. Accent = high profits Bolton = low acquisition rate
B. Accent = unprofitable business Bolton = low acquisition rate
C. Accent = high profits Bolton = high acquisition rate
D. Accent = unprofitable business Bolton = high acquisition rate
正解：B

質問 6：
The following statements are about pure risk and speculative risk-two kinds of risk that both businesses and individuals experience. Select the answer choice containing the correct statement.
A. Only pure risk involves the possibility of gain.
B. Healthcare coverage is designed to help plan members avoid pure risk, not speculative risk.
C. Only speculative risk contains an element of uncertainty.
D. An example of speculative risk is the possibility that an individual will contract a serious illness.
正解：B