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

Encourage Sunrise's physicians to perform services that are not medically necessary

Completely eliminate service risk for Sunrise's physicians

Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers

Help stabilize expenses for Sunrise

Referral circle capitation

Risk pod capitation

Contact capitation

Retrospective reimbursement capitation

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.