AHM-520 Exam Dumps - Health Plan Finance and Risk Management

For each of its products, the Wisteria Health Plan monitors the provider reimbursement trend and the residual trend. One true statement about these trends is that

A stop-loss contract may provide that claims are settled using a paid claims method or an incurred claims method. The Concord Company provides health coverage to its employees through a self-funded health plan. On March 17, a Concord employee who is enrolled in this plan underwent surgery, and the surgery was sufficiently expensive to trigger Concord's specific stop-loss coverage. On April 10, Concord paid the medical expenses associated with the surgery. The term of the stop-loss contract ended on April 1. This information indicates that the stop-loss carrier is responsible for paying a portion of the cost of the surgery under

The Cardinal health plan complies with all of the provisions of HIPAA.

Cardinal has received requests for healthcare coverage from the following companies that meet the statutory definition of a small group:

• The Xavier Company has excellent claims experience
• The Youngblood Company has not previously offered group healthcare coverage to its employees
• The Zebulon Company has poor claims experience

According to HIPAA's provisions, Cardinal must issue a healthcare contract to

The accounting department of the Enterprise health plan adheres to the following policies:

• Policy A—Report gains only after they actually occur
• Policy B—Report losses immediately
• Policy C—Record expenses only when they are certain
• Policy D—Record revenues only when they are certain

Of these Enterprise policies, the ones that are consistent with the accounting principle of conservatism are Policies

Kevin Olin applied for individual healthcare coverage from the Mercury health plan. Before issuing the policy, Mercury's underwriters attached a rider that excludes from coverage any loss that results from Mr. Olin's chronic knee problem. This information indicates that Mr. Olin's policy includes

This concept, which is an extension of the going-concern concept, holds that the value of an asset that a company reports in its accounting records should be the asset's historical cost, not its current market value. Although this concept offers objectivity and reliability, it may lack relevance, particularly for assets held for a long period of time.

From the following answer choices, choose the name of the accounting concept that matches the description.

As part of the first step in its strategic planning process, the Trout health plan developed the following statements:

• Statement A—Trout will deliver quality healthcare to our customers at a reasonable cost.
• Statement B—Within five years, Trout will be recognized as the industry leader in all of our markets.

Statement A can best be described as a

The following statement(s) can correctly be made about a health plan's underwriting of small groups: