AHM-520 Exam Dumps : Health Plan Finance and Risk Management

The net effect of using provider reimbursement contracts to transfer risk is that the health plan’s net worth requirement increases.

Once the health plan has transferred utilization risk to its providers, it is relieved of the legal obligation to provide medical services to plan members in the event of the provider’s insolvency.

The greater the amount of risk the health plan transfers to providers, the larger the credit-risk factor becomes in the health plan’s RBC formula.

By decreasing its utilization risk, the health plan increases its underwriting risk.

Internal analysis of the health plan can be more detailed and more specific than can external analysis

Internal analysts are more likely than external analysts to want comparative financial data about the health plan

Only internal analysts use trend analysis to analyze the health plan's financial statements

Only internal analysts typically conduct the financial analysis of the health plan themselves

Is the most common type of capitation

Is less attractive to providers when the arrangement sets provisions to limit risk

Sets provider reimbursement at a specific dollar amount per plan member

Transfers some of the risk associated with underwriting and rating from a health plan to a provider