QUESTION: 17 Exam Topic: 1, Volume A

Mandated benefit laws are state or federal laws that require health plans to arrange for the financing and delivery of particular benefits. Within a market, the implementation of mandated benefit laws is likely to cause __________.

A reduction in the number of self-funded healthcare plans
An increase in the cost to the health plans
A reduction in the size of the provider panels of health plans
A reduction in the uniformity among the healthcare plans of competing health plans

Answer(s): B

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QUESTION: 18 Exam Topic: 1, Volume A

The physicians who work for the Sunrise Health Plan, a staff model HMO, are paid a salary that is not augmented with another type of incentive plan. Compared to the use of a traditional reimbursement method, Sunrise's use of a salary reimbursement method is more likely to

Encourage Sunrise's physicians to perform services that are not medically necessary
Completely eliminate service risk for Sunrise's physicians
Decrease Sunrise's liability for any negligent acts of the physicians in the plan's network of providers
Help stabilize expenses for Sunrise

Answer(s): D

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QUESTION: 19 Exam Topic: 1, Volume A

The Acorn Health Plan uses a resource-based relative value scale (RBRVS) to help determine the reimbursement amounts that Acorn should make to providers who are compensated under an FFS system. With regard to the advantages and disadvantages to Acorn of using RBRVS, it can correctly be stated that

An advantage of using RBRVS is that it can assist Acorn in developing reimbursement schedules for various types of providers in a comprehensive healthcare plan
An advantage of using RBRVS is that it puts providers who render more medical services than necessary at financial risk for this overutilization
A disadvantage of using RBRVS is that it will be difficult for Acorn to track treatment rates for the health plan's quality and cost management functions
A disadvantage of using RBRVS is that it rewards procedural healthcare services more than cognitive healthcare services

Answer(s): A

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QUESTION: 20 Exam Topic: 1, Volume A

Health plans sometimes use global fees to reimburse providers. Health plans would use this method of provider reimbursement for all of the following reasons EXCEPT that global fees

Eliminate any motivation the provider may have to engage in churning
Transfer some of the risk of overutilization of care from the health plan to the providers
Eliminate the practice of upcoding within specific treatments
Reward providers who deliver cost-effective care

Answer(s): A

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QUESTION: 17 Exam Topic: 1, Volume A

QUESTION: 18 Exam Topic: 1, Volume A

QUESTION: 19 Exam Topic: 1, Volume A

QUESTION: 20 Exam Topic: 1, Volume A