AHM-520 Free Practice Test

- (Topic 1)
Because a health plan cannot decline coverage for individuals who are eligible for conversion of group health coverage to individual health coverage, the bulk of the health plan's underwriting for conversion policies is accomplished through health plan design.

1. A. True
2. B. False

Correct Answer: A

- (Topic 2)
Doctors’ Care is an individual practice association (IPA) under contract to the Jasper Health Plan to provide primary and secondary care to Jasper’s members. Jasper’s capitation payments compensate Doctors’ Care for all physician services and associated diagnostic tests and laboratory work. The physicians at Doctors’ Care, as a group, determine how individual physicians in the group will be remunerated. The type of capitation used by Jasper to compensate Doctors’ Care is known as:

1. A. PCP capitation
2. B. Partial capitation
3. C. Full professional capitation
4. D. Specialty capitation

Correct Answer: C

- (Topic 2)
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:

1. A. 50% of D
2. B. Lui's reimbursement
3. C. 75% of D
4. D. Lui's reimbursement
5. E. 90% of D
6. F. Lui's reimbursement
7. G. 100% of D
8. H. Lui's reimbursement

Correct Answer: D

- (Topic 1)
If Grace Wilson is eligible for benefits under both the Medicare and Medicaid programs, then

1. A. Medicare is M
2. B. Wilson's primary insurer
3. C. A Medicare- or Medicaid-contracting health plan is allowed to lock-in M
4. D. Wilson's enrollment for a maximum period of 24 months
5. E. The BBA requires the state to guarantee M
6. F. Wilson's eligibility for a minimum of 18 months once she enrolls in a health plan network
7. G. M
8. H. Wilson can only receive Medicare- or Medicaid-covered services from a provider who participates in a health plan network

Correct Answer: A

- (Topic 2)
Geena Falk is eligible for both Medicare and Medicaid coverage. If Ms. Falk incurs a covered expense, then:

1. A. Medicaid will be M
2. B. Falk’s primary insurer
3. C. Medicare will be M
4. D. Falk’s primary insurer
5. E. Either Medicare or Medicaid will be M
6. F. Falk’s primary insurer depending on her election
7. G. Medicare and Medicaid will each be responsible for one-half of M
8. H. Falk’s covered expense

Correct Answer: B