QUESTION: 9 Exam Topic: 1, Volume A

Provider reimbursement methods that transfer some utilization risk from a health plan to providers affect the health plan's RBC formul

A health plan's use of these reimbursement methods is likely to result in
An increase the health plan's underwriting risk
A decrease the health plan's credit risk
A decrease the health plan's net worth requirement
All of the above

Answer(s): C

Reveal Solution Next Question

QUESTION: 10 Exam Topic: 1, Volume A

Three general strategies that health plans use for controlling types of risk are risk avoidance, risk transfer, and risk acceptance. The following statements are about these strategies. Three of these statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

Generally, the smaller the likely benefits of accepting a risk, and the lower the costs of avoiding that risk, the greater the likelihood that a health plan will elect to avoid the risk.
A health plan is seldom able to transfer any of the risk that utilization rates will be higher than expected and that its cost of providing healthcare will exceed the revenues it receives.
If a risk is a pure risk from the point of view of a health plan, then the health plan most likely will attempt to avoid the risk.
A health plan would most likely transfer some or all of its utilization risk if it pays a provider a rate that is based on the number of plan enrollees that choose the provider as their primary care provider (PCP).

Answer(s): B

Reveal Solution Next Question

QUESTION: 11 Exam Topic: 1, Volume A

Under the doctrine of corporate negligence, a health plan and its physician administrators may be held directly liable to patients or providers for failing to investigate adequately the competence of healthcare providers whom it employs or with whom it contracts, particularly where the health plan actually provides healthcare services or restricts the patient's/enrollee's choice of physician.

True
False

Answer(s): A

Reveal Solution Next Question

QUESTION: 12 Exam Topic: 1, Volume A

The Eagle health plan wants to limit the possibility that it will be held vicariously liable for the negligent acts of providers. Dr. Michael Chan is a member of an independent practice association

(IPA) that has contracted with Eagle. One step that Eagle could take in order to limit its exposure under the theory of vicarious liability is to

Supply Dr. Chan with office space
Employ nurses, laboratory technicians, and therapists to support Dr.Chan
Be responsible for keeping Dr. Chan's medical records updated
Ensure that documents provided to Dr. Chan's patients describe him as an independent practitioner

Answer(s): D

Reveal Solution Next Question

Free AHM-520 Exam Braindumps (page: 3)

QUESTION: 9 Exam Topic: 1, Volume A

QUESTION: 10 Exam Topic: 1, Volume A

QUESTION: 11 Exam Topic: 1, Volume A

QUESTION: 12 Exam Topic: 1, Volume A