AHIP AHM-520 Quiz 1 Topic 1 Questions 1-5

Question: 1

The Eagle health plan wants to limit the possibility that it will be held vicariously liable for the negligent acts of providers. Dr. Michael Chan is a member of an independent practice association (IPA) that has contracted with Eagle. One step that Eagle could take in order to limit its exposure under the theory of vicarious liability is to

ASupply Dr. Chan with office space

BEmploy nurses, laboratory technicians, and therapists to support Dr.Chan

CBe responsible for keeping Dr. Chan's medical records updated

DEnsure that documents provided to Dr. Chan's patients describe him as an independent practitioner

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Question: 2

Cascade Hospital has negotiated with the McBee Health Plan a straight per-diem rate of $1,000 per day for medical admissions. One of McBee's plan members was admitted to Cascade for 10 days. Total billed charges equaled $10,000, of which $2,000 were for noncovered items. This information indicates that, for this admission, the amount that McBee was obligated to reimburse Cascade was:

A$0

B$8,000

C$10,000

D$12,000

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Question: 3

The following statements are about carve-out programs. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

AIn the type of carve-out in which entire categories of care are administered by independent organizations, a health plan typically reimburses these organizations under an FFS contract.

BTypically, a health plan will offer carved-out services to its enrollees, but will manage these services separately.

CCarve-outs are services that are excluded from a capitation payment, a risk pool, or a health benefit plan.

DThe most rapidly growing area related to carve-outs is disease management (DM).

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Question: 4

The purest form of a self-funded benefit plan is one in which the employer pays benefits from current revenue, administers all aspects of the plan, and bears the risk that actual benefit payments will exceed the expected amount of payments. A decision to use this kind of self-funding is generally considered most desirable when certain conditions are present. These conditions most likely include that the benefit plan

AIs a contributory plan

BIs subject to collective bargaining C. Is unable to secure discounts from the physicians who provide medical services to the plan members

DHas a relatively high frequency of low severity claims

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Question: 5

Costs that can be defined by behavior are most commonly classified as fixed costs, variable costs and semi-variable costs. Examples of fixed costs include:

ARent, insurance expense, and depreciation on computer equipment

BRent, claims processing costs, and selling expenses

CClaims processing costs, telephone expense, and depreciation on computer equipment

DPremium processing, rent, and selling expenses

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AHIP AHM-520 Quiz:1 Topic:1 Questions:1-5