Free AHIP AHM-520 Exam Questions

Become AHIP Certified with updated AHM-520 exam questions and correct answers

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Total 215 Questions | Updated On: Sep 23, 2026

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Question 1

In order to determine a health plan's quick liquidity ratio, a financial analyst would divide the health plan's:

A : Total assets not invested in affiliates by its total liabilities

B : Liquid assets by its total liabilities

C : Liquid assets by its contractual reserves

D : Total assets by its contractual reserves

Answer: C

Question 2

The following statements are about the financial risks for health plans in Medicare and Medicaid markets. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

A : One reason that health plans in the Medicare and Medicaid markets experience financial risk is that government regulations determine which services must be provided to Medicare and Medicaid enrollees.

B : Effective use of hospital utilization is the single most likely factor to contribute to the success of a Medicare-contracting health plan.

C : If a Medicare-contracting health plan is a provider-sponsored organization (PSO), it is prohibited from sharing financial risk with its providers.

D : Typically, providers are more reluctant to accept financial risk in connection with providing services to the Medicaid population than with providing services to the Medicare population.

Answer: C

Question 3

In a fee-for-service (FFS) reimbursement method, providers are paid per treatment or per service that they provide.

One typical benefit of FFS reimbursement is that it:

A : Is highly effective in preventing excessive services that take the form of churning, unbundling, and upcoding

B : Provides physicians who attempt to control costs with a higher rate of compensation than is provided to physicians who make the effort to control costs

C : Is relatively easy to initiate, especially in markets where managed care penetration is low

D : Guards against the practice of defensive medicine

Answer: B

Question 4

Federal law addresses the relationship between Medicare- or Medicaid contracting health plans and providers who are at "substantial financial risk."

Under federal law, Medicare- or Medicaid-contracting health plans:

A : Place a provider at "substantial risk" whenever incentive arrangements put the provider at risk for amounts in excess of 10% of his or her total potential reimbursement for providing services to Medicare and Medicaid enrollees

B : Must provide stop-loss coverage to a provider who is placed at "substantial financial risk" for services that the provider does not directly provide to Medicare or Medicaid enrollees

C : Both A and B

D : A only

E : B only

F : Neither A nor B

Answer: C

Question 5

The purest form of a self-funded benefit plan is one in which the employer pays benefits from current revenue, administers all aspects of the plan, and bears the risk that actual benefit payments will exceed the expected amount of payments. A decision to use this kind of self-funding is generally considered most desirable when certain conditions are present.

These conditions most likely include that the benefit plan:

A : Is a contributory plan

B : Is subject to collective bargaining

C : Is unable to secure discounts from the physicians who provide medical services to the plan members

D : Has a relatively high frequency of low severity claims

Answer: D

Page: 1 / 43

Total 215 Questions | Updated On: Sep 23, 2026

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