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

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Question # 4

The following statements are about 501(c)(9) trusts. Select the answer choice containing the correct statement:

In the event a 501(c)(9) trust is terminated, any funds remaining in the trust revert back to the employer.

In order to satisfy Internal Revenue Code (IRC) requirements, membership in a 501(c)(9) trust is mandatory for all employees.

Contributions made by an employer to a 501(c)(9) trust are deductible for federal income tax purposes.

Typically, a 501(c)(9) trust is controlled solely by the employer that established the trust.

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Question # 5

Juan Ramirez, a licensed social worker, and Dr. Laura Lui, a licensed psychiatrist, are under contract to the Peninsula Health Plan. Peninsula has contracted with CMS to provide services to Medicare and Medicaid beneficiaries. Both Mr. Ramirez and Dr. Lui provide the same type of counseling services to Peninsula's enrollees. With respect to amendments made to the Balanced Budget Act (BBA) of 1997 that impact provider reimbursement, the amount by which Peninsula will reimburse Mr. Ramirez will be equal to:

50% of Dr. Lui's reimbursement

75% of Dr. Lui's reimbursement

90% of Dr. Lui's reimbursement

100% of Dr. Lui's reimbursement

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Question # 6

Mandated benefit laws are state or federal laws that require health plans to arrange for the financing and delivery of particular benefits. Ways that mandated benefits have the potential to influence health plans include:

1. Causing a lower degree of uniformity among health plans of competing health plans in a given market

2. Increasing the cost of the benefit plan to the extent that the plan must cover mandated benefits that would not have been included in the plan in the absence of the law or regulation that mandates the benefits

Both 1 and 2

1 only

2 only

Neither 1 nor 2

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Question # 7

Dr. Martin Cassini is an obstetrician who is under contract with the Bellerby Health Plan. Bellerby compensates Dr. Cassini for each obstetrical patient he sees in the form of a single amount that covers the costs of prenatal visits, the delivery itself, and post-delivery care . This information indicates that Dr. Cassini is compensated under the provider reimbursement method known as a:

global fee

relative value scale

unbundling

discounted fee-for-service

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Question # 8

The Column health plan is in the process of developing a strategic plan.

The following statements are about this strategic plan. Three of the statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

Human resources most likely will be a critical component of Column's strategic plan because, in health plan markets, the size and the quality of a health plan's provider network is often more important to customers than are the details of a product's benefit design.

Column's strategic plan should only address how the health plan will differentiate its products, rather than where and how it will sell these products.

Column most likely will need to develop contingency plans to address the need to make adjustments to its original strategic plan.

Column's information technology (IT) strategy most likely will be a critical element in successfully implementing the health plan's strategic plan.

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