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Free AHM-520 Exam Braindumps (page: 14)

Page 13 of 55
PDF with 215 Questions

With regard to the Medicaid program in the United States, it can correctly be stated that

  1. The federal government provides none of the funding for state Medicaid programs
  2. Federal Medicaid law is different from Medicare law in that the federal government explicitly sets forth the methodology for payment of Medicaid-contracting plans but not Medicare-contracting plans
  3. A state's payment to health plans for providing Medicaid services cannot be more than it would have cost the state to provide the services under Medicaid fee-for-service (FFS)
  4. States are prohibited from carving out specific services from the capitation rate that health plans receive for providing Medicaid services

Answer(s): C



Providing services under Medicare or Medicaid can impose on health plans financial risks and costs that are greater than those related to providing services to the commercial population. Reasons that an health plan's financial risks and costs for providing services to Medicare and Medicaid enrollees tend to be higher include

  1. Most Medicare and Medicaid enrollees can disenroll from a health plan on a monthly basis
  2. The high incidences of chronic illness in both the Medicare and Medicaid populations results in higher costs related to coordinating care and case management
  3. Medicare and Medicaid enrollees tend to have a high level of costs in the first few months of enrollment as the health plan educates them about the health plan system and performs initial health screening to evaluate their health
  4. all of the above

Answer(s): D



If Grace Wilson is eligible for benefits under both the Medicare and Medicaid programs, then

  1. Medicare is Ms. Wilson's primary insurer
  2. A Medicare- or Medicaid-contracting health plan is allowed to lock-in Ms. Wilson's enrollment for a maximum period of 24 months
  3. The BBA requires the state to guarantee Ms. Wilson's eligibility for a minimum of 18 months once she enrolls in a health plan network
  4. Ms. Wilson can only receive Medicare- or Medicaid-covered services from a provider who participates in a health plan network

Answer(s): A



Federal law addresses the relationship between Medicare- or Medicaid contracting health plans and providers who are at "substantial financial risk."

Under federal law, Medicare- or Medicaid-contracting health plans

A Place a provider at "substantial risk" whenever incentive arrangements put the provider at risk for amounts in excess of 10% of his or her total potential reimbursement for providing services to Medicare and Medicaid enrollees
B) Must provide stop-loss coverage to a provider who is placed at "substantial financial risk" for services that the provider does not directly provide to Medicare or Medicaid enrollees

  1. Both A and B
  2. A only
  3. B only
  4. Neither A nor B

Answer(s): C






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