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

favorable for both expenses and revenues

favorable for expenses, but unfavorable for revenues

favorable for revenues, but unfavorable for expenses

unfavorable for both expenses and revenues

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

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.