Question 1

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

Options :

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

Julio Benini is eligible to receive healthcare coverage through a health plan that is under contract to his employer. Mr. Benini is seeking coverage for the following individuals:

Elena Benini, his wife -

Maria Benini, his 18-year-old unmarried daughter

Johann Benini, his 80-year-old father who relies on Julio for support and maintenance

The health plan most likely would consider that the definition of a dependent, for purposes of healthcare coverage, applies to:

Options :

A : Elena, Maria, and Johann

B : Elena and Maria only

C : Elena only

D : Maria only

Answer: B

Question 3

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 4

The Fairway health plan is a for-profit health plan that issues stock. The following data was taken from Fairway's financial statements:

Current assets.....$5,000,000 -

Total assets.....$6,000,000 -

Current liabilities.....$2,500,000

Total liabilities.....$3,600,000

Stockholders' equity.....$2,400,000

Fairway's total revenues for the previous financial period were $7,200,000, and its net income for that period was $180,000.

Assume that the healthcare industry average for the debt-to-equity ratio is 0.90.

The following statement(s) can correctly be made about Fairway's debt to equity ratio:

Options :

A : Fairway-s debt-to-equity ratio is 1.50

B : Fairway relies less than most other healthcare organizations on borrowed funds to cover future and current benefit payments, to pay for ongoing business operations, and to finance growth

C : Both A and B

D : A only

E : B only

F : Neither A nor B

Answer: B

Question 5

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:

Options :

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

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