Question 1

A health plan can use segment margins to evaluate the profitability of its profit centers.

One characteristic of a segment margin is that this margin:

Options :

A : Is the portion of the contribution margin that remains after a segment has covered its direct fixed costs

B : Incorporates only the costs attributable to a segment, but it does not incorporate revenues

C : Considers only a segment-s costs that fluctuate in direct proportion to changes in the segment-s level of operating activity

D : Evaluates the profit center-s effective use of assets employed to earn a profit

Answer: A

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.

Options :

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

Under GAAP, three approaches to expense recognition are generally allowed: associating cause and effect, systematic and rational allocation, and immediate recognition.

A health plan most likely would use the approach of systematic and rational allocation in order to:

Options :

A : Report the payment of the health plan-s utility bills

B : Spread the payment of sales force commissions over the premium paying period of healthcare coverage

C : Report the fees paid by the health plan to attorneys and consultants

D : Depreciate the cost of a new computer system over the useful life of the system

Answer: D

Question 4

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:

Options :

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

Question 5

The Atoll Health Plan must comply with a number of laws that directly affect the plan's contracts. One of these laws allows Atoll's plan members to receive medical services from certain specialists without first being referred to those specialists by a primary care provider (PCP). This law, which reduces the PCP's ability to manage utilization of these specialists, is known as _________.

Options :

A : A due process law

B : An any willing provider law

C : A direct access law

D : A fair procedure law

Answer: C

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