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

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

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.

Effective use of hospital utilization is the single most likely factor to contribute to the success of a Medicare-contracting health plan.

If a Medicare-contracting health plan is a provider-sponsored organization (PSO), it is prohibited from sharing financial risk with its providers.

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.

A reduction in the number of self-funded healthcare plans

An increase in the cost to the health plans

A reduction in the size of the provider panels of health plans

A reduction in the uniformity among the healthcare plans of competing health plans