Free AHM-510: Governance and Regulation Exam Questions and Answers

Last updated: September 13, 2026

Exam code

AHM-510

Provider

AHIP

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1000+

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First 10, with answers

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130 mins · 70%

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1. Question #1

   Regulatory and legislative bodies are among the important environmental forces in the health plan industry. The following statements are about such regulation and legislation. Select the answer choice that contains the correct statement.

   • A. As stakeholders in the health plan industry, federal and state governments exert tremendous influence over a health plan's formation and operations.
   • B. Administrative rules and regulations do not carry the force of law.
   • C. In recent years, the number of health plan bills in the state and the federal legislatures has decreased.
   • D. Federal guidelines exist to direct health plans on compliance issues when a health plan encounters conflicting state laws in a given service area.
   Reveal Answer

2. Question #2

   Any willing provider laws have their share of proponents and opponents. Arguments commonly made in opposition to any willing provider laws include

   • A. That such laws limit consumer choice to coverage options that are more costly than networkbased plans
   • B. All of the above
   • C. That such laws encourage providers to offer discounts in exchange for patient volume
   • D. That such laws reduce the number of providers in a health plan's network
   Reveal Answer

3. Question #3

   Health maintenance organizations (HMOs) seeking federal qualification under the HMO Act of 1973 and its amendments must meet requirements in four basic operational areas. One operational requirement for qualification is that an HMO must

   • A. Ensure that at least 1/3 of its policy-making body is comprised of HMO members
   • B. Ensure that there is adequate representation of underserved communities on its policy-making body
   • C. Have an ongoing quality assurance program that meets the requirements of the Centers for Medicaid & Medicare Services (CMS), stresses health outcomes,
   • D. Test, safeguard, and promote quality of care by following detailed programmatic techniques that are explained in CMS's Federally Qualified HMO (FQHMO)
   Reveal Answer

4. Question #4

   In 1994, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) revised their 1993 healthcare-specific antitrust guidelines to include analytical principles relating to multiprovider networks. Under the new guidelines, the regulatory agencies will use the rule of reason to analyze joint pricing activities by competitors in physician or multiprovider networks only if

   • A. Provider integration under the network is likely to produce significant efficiencies that benefit consumers
   • B. The combining of providers into a joint venture enables the providers to offer a new product
   • C. All of the above
   • D. The providers in a network share substantial financial risk
   Reveal Answer

5. Question #5

   The following statements appear in the Twilight Health Plan's strategic plan: Increase the percentage of preventive health interventions for total eligible membership during each of the next three calendar years for the following services: mammography, Pap smears, immunizations, and first trimester visits for prenatal mothers Improve customer satisfaction on an annual basis for each of the next three calendar years, as measured by satisfaction surveys for members, providers, and employer groups Increase by 30% the number of claims processed by the automated claim payment system and reduce by 10% the cost of paying claims during the next three years These statements are examples of Twilight's

   • A. Corporate strategies
   • B. Corporate objectives
   • C. Company mission
   • D. Company vision
   Reveal Answer

6. Question #6

   1. Which document outlines the key organizational structure of a health plan?

   • A. Compliance Manual
   • B. Articles of Incorporation
   • C. Operational Budget
   • D. Strategic Plan
   Reveal Answer

7. Question #7

   2. In what scenario is it essential for a health plan to conduct a risk assessment?

   • A. Before new product rollout
   • B. When a major incident occurs
   • C. At the end of a fiscal year
   • D. During annual audits
   Reveal Answer

8. Question #8

   3. What is the role of actuaries in governance within a health plan?

   • A. Evaluate financial risks
   • B. Design healthcare facilities
   • C. Develop marketing strategies
   • D. Conduct clinical studies
   Reveal Answer

9. Question #9

   4. How often should a health plan review its compliance program?

   • A. Daily
   • B. Monthly
   • C. Every 5 years
   • D. Annually
   Reveal Answer

10. Question #10

    5. What aspect of governance helps in ensuring ethical behavior in health plans?

    • A. Training programs
    • B. Product development
    • C. Marketing strategies
    • D. Financial audits
    Reveal Answer