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AHIP AHM-520 Exam With Confidence Using Practice Dumps

Exam Code:
AHM-520
Exam Name:
Health Plan Finance and Risk Management
Certification:
Vendor:
Questions:
215
Last Updated:
Jan 24, 2026
Exam Status:
Stable
AHIP AHM-520

AHM-520: AHIP Certification Exam 2025 Study Guide Pdf and Test Engine

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Health Plan Finance and Risk Management Questions and Answers

Question 1

The physicians who work for the Sunrise Health Plan, a staff model HMO, are paid a salary that is not augmented with another type of incentive plan. Compared to the use of a traditional reimbursement method, Sunrise's use of a salary reimbursement method is more likely to

Options:

A.

Encourage Sunrise's physicians to perform services that are not medically necessary

B.

Completely eliminate service risk for Sunrise's physicians

C.

Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers

D.

Help stabilize expenses for Sunrise

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Question 2

The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures:

  • Preferred provider organization (PPO)
  • Group model HMO
  • Staff model health maintenance organization (HMO)
  • Traditional health insurance

Of these health plan products, the one that would most likely expose a health plan to the highest risk is the:

Options:

A.

preferred provider organization (PPO)

B.

group model HMO

C.

staff model health maintenance organization (HMO)

D.

traditional health insurance

Question 3

The risk-based capital formula for health plans defines a number of risks that can impact a health plan’s solvency. These categories reflect the fact that the level of risk faced by health plans is significantly impacted by provider reimbursement methods that shift utilization risk to providers. The following statements are about the effect of a health plan transferring utilization risk to providers. Select the answer choice containing the correct statement:

Options:

A.

The net effect of using provider reimbursement contracts to transfer risk is that the health plan’s net worth requirement increases.

B.

Once the health plan has transferred utilization risk to its providers, it is relieved of the legal obligation to provide medical services to plan members in the event of the provider’s insolvency.

C.

The greater the amount of risk the health plan transfers to providers, the larger the credit-risk factor becomes in the health plan’s RBC formula.

D.

By decreasing its utilization risk, the health plan increases its underwriting risk.