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

Medicaid will be Ms. Falk’s primary insurer

Medicare will be Ms. Falk’s primary insurer

Either Medicare or Medicaid will be Ms. Falk’s primary insurer depending on her election

Medicare and Medicaid will each be responsible for one-half of Ms. Falk’s covered expense

Interest charge

Retention charge

Risk charge

Surplus

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.