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

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.

Are locked into a plan for a 12-month period, whereas enrollees from the commercial population may disenroll from a plan on a monthly basis

Require less enrollee education than do enrollees from the commercial population

Have higher incidences of chronic illness than do enrollees from the commercial population

Are enrolled in a health plan through a group situation, whereas the commercial population typically enrolls in a health plan on an individual basis

Referral circle capitation

Risk pod capitation

Contact capitation

Retrospective reimbursement capitation