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

A health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

The Marble Health Plan sets aside a PMPM amount for each specialty.

When a PCP in Marble's provider network refers a Marble plan member to a specialist and the specialist provides medical services to the member, the specialist begins to receive a share of those funds on a monthly basis. Marble determines the monthly payment for each specialist by dividing the number of active patients for that specialty by the total specialty pool for that month.

This form of payment, which is similar to a case rate, is known as

One true statement about a type of capitation known as a percent-of-premium arrangement is that this arrangement