最新なAHIP AHM-520問題集（215題）、真実試験の問題を全部にカバー！

質問 1：
In order to show the efficiency of a health plan's managers in using the health plan's investments to earn a return for stockholders, a financial analyst most likely would use a type of profitability ratio known as
A. A net gain-to-total income ratio
B. An insurance leverage ratio
C. A statutory return on assets (ROA) ratio
D. A gross profit ratio
正解：C

質問 2：
The Violin Company offers its employees a triple option of health plans: an HMO, an HMO with a point of service (POS) option, and an indemnity plan.
Premiums are lowest for the HMO option and highest for the indemnity plan. Violin employees who anticipate that they will be individual low utilizes of healthcare services are most likely to enroll in the
A. HMO and are least likely to enroll in the indemnity plan
B. Indemnity plan and are least likely to enroll in the HMO
C. Indemnity plan and are least likely to enroll in the HMO with the POS option
D. HMO and are least likely to enroll in the HMO with the POS option
正解：A

質問 3：
The Arista Health Plan is evaluating the following four groups that have applied for group healthcare coverage:
The Blaise Company, a large private employer
The Colton County Department of Human Services (DHS)
A multiple-employer group comprised of four companies
The Professional Society of Daycare Providers
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With respect to the relative degree of risk to Arista represented by these four companies,
the company that would most likely expose Arista to the lowest risk is the:
A. Professional Society of Daycare Providers
B. Multiple-employer group
C. Blaise Company
D. Colton County DHS
正解：C

質問 4：
The provider contract that Dr. Zachery Cogan, an internist, has with the Neptune Health Plan calls for Neptune to reimburse him under a typical PCP capitation arrangement. Dr. Cogan serves as the PCP for Evelyn Pfeiffer, a Neptune plan member. After hospitalizing Ms. Pfeiffer and ordering several expensive diagnostic tests to determine her condition, Dr. Cogan referred her to a specialist for further treatment. In this situation, the compensation that Dr. Cogan receives under the PCP capitation arrangement most likely includes Neptune's payment for
A. His visits to Ms. Pfeiffer while she was hospitalized
B. All of the above
C. The cost of the services that the specialist performed for Ms. Pfeiffer
D. All of the diagnostic tests that he ordered on Ms. Pfeiffer
正解：A

質問 5：
Many clinicians are concerned about the development of practice guidelines that seek to define appropriate healthcare services that should be provided to a patient who has been diagnosed with a specific condition. To avoid the risk associated with using such guidelines, health plans should advise clinicians that the existence of such a guideline:
1.Establishes standards of care to be routinely utilized with all patients presenting a specific condition
2.Preempts a physician's judgment when assessing the specific factors related to a patient's condition
A. 2 only
B. 1 only
C. Neither 1 nor 2
D. Both 1 and 2
正解：C

質問 6：
The Cardinal health plan complies with all of the provisions of HIPAA.
Cardinal has received requests for healthcare coverage from the following companies that meet the statutory definition of a small group:
- The Xavier Company has excellent claims experience - The Youngblood Company has not previously offered group healthcare coverage to its employees - The Zebulon Company has poor claims experience
According to HIPAA's provisions, Cardinal must issue a healthcare contract to
A. None of these companies
B. Xavier only
C. Xavier and Youngblood only
D. Xavier, Youngblood, and Zebulon
正解：D

質問 7：
The Jamal Health Plan operates in a state that mandates that a health plan either allow providers to become part of its network or reimburse those providers at the health plan's negotiated-contract rate, so long as the non-contract provider is willing to perform the services at the contract rate. This type of law is known as:
A. An any willing provider law
B. A direct access law
C. A due process law
D. A fair procedure law
正解：A

質問 8：
The following information was presented on one of the financial statements prepared by the Rouge Health Plan as of December 31, 1998:

Rouge's current ratio at the end of 1998 was approximately equal to:
A. 0.84
B. 1.19
C. 1.06
D. 1.31
正解：B

質問 9：
A primary reason that a financial analyst would measure the Tapestry health plan's return on assets (ROA) is to determine the
A. Proportion of earnings paid out to Tapestry stockholders in the form of cash dividends
B. Rate of return on the book value of the stockholders' investment in Tapestry
C. Efficiency of Tapestry's management
D. Amount of net income per share of Tapestry's common stock
正解：C