AHM-530 Free Practice Test

- (Topic 2)
Factors that are likely to indicate increased health plan market maturity include:

1. A. Increased consolidation among health plans.
2. B. Increased rate of growth in health plan premium levels.
3. C. Areduction in the market penetration of HMO and point-of-service (POS) products.
4. D. Areduction in the frequency of performance-based reimbursement of providers.

Correct Answer: A

- (Topic 1)
In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.
In most states, a health plan can be held responsible for a provider’s negligent malpractice. This legal concept is known as (vicarious liability / risk sharing). One step that health plans can take to reduce their exposure to malpractice lawsuits is to state in health plan-provider agreements,marketing collateral, and membership literature that the providers are (employees of the health plan / independent contractors).

1. A. Vicarious liability / employees of the health plan
2. B. Vicarious liability / independent contractors
3. C. Risk sharing / employees of the health plan
4. D. Risk sharing / independent contractors

Correct Answer: B

- (Topic 1)
Jay Mercer is covered under his health plan’s vision care plan, which includes coverage for clinical eye care but not for routine eye care. Recently, Mr. Mercer had a general eye examination and got a prescription for corrective lenses. Mr. Mercer’s vision care plan will cover.

1. A. both the general eye examination and the prescription for corrective lenses
2. B. the general eye examination only
3. C. the prescription for corrective lenses only
4. D. neither the general eye examination nor the prescription for corrective lenses

Correct Answer: D

- (Topic 1)
One important aspect of network management is profiling, or provider profiling. Profiling is most often used to

1. A. measure the overall performance of providers who are already participants in the network
2. B. assess a provider’s overall satisfaction with a plan’s service protocols and other operational areas
3. C. verify a prospective provider’s professional licenses, certifications, and training
4. D. familiarize a provider with a plan’s procedures for authorizations and referrals

Correct Answer: A

- (Topic 1)
The sizes of the businesses in a market affect the types of health programs that are likely to be purchased. Compared to smaller employers (those with fewer than 100 employees), larger employers (those with more than 1,000 employees) are

1. A. more likely to contract with indemnity health plans
2. B. more likely to offer their employees a choice in health plans
3. C. less likely to contract with health plans
4. D. less likely to require a wide variety of benefits

Correct Answer: B