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

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.

Causes Dr. Meyer's capitation contract with Cardigan to transfer more risk to him than the contract otherwise would transfer

Specifies that Cardigan will pay Dr. Meyer under an arrangement other than capitation until a specified number of children covered by the plan use him as their PCP

Both A and B

A only

B only

Neither A nor B