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

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

preferred provider organization (PPO)

group model HMO

staff model health maintenance organization (HMO)

traditional health insurance

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.