QUESTION: 73

One true statement about the compensation arrangement known as the case rate system is that, under this system,

Providers stand to gain or lose based on the number and types of treatments used for each case
Providers have no incentives to take an active role in managing cost and utilization
Payors cannot adjust standard case rates to reflect the severity of the patient's condition or complications that arise from multiple medical problems
Payors have the opportunity to benefit from the provider's cost savings

Answer(s): A

Health plans often negotiate compensation arrangements that transfer some or all of the financial risk associated with delivering healthcare services to network providers. The following statements are about these compensation arrangements. Select the answer choice containing the correct statement.

A per diem system typically places a healthcare facility at risk for controlling utilization and costs internally.
One likely reason that an health plan would use a fee schedule system to compensate providers is that this system transfers most of the financial risk to the provider.
Under a salary system, a provider assumes no service risk.
The use of a FFS or a salary system allows an health plan to transfer a greater proportion of financial risk to providers than does the use of capitation.

Answer(s): A

Reveal Solution Next Question

QUESTION: 75

An health plan enters into a professional services capitation arrangement whenever the health plan

Contracts with a medical group, clinic, or multispecialty IPA that assumes responsibility for the costs of all physician services related to a patient's care
Pays individual specialists to provide only radiology services to all plan members
Transfers all financial risk for healthcare services to a provider organization and the provider, in turn, covers virtually all of a patient's medical expenses
Contracts with a primary care provider to cover primary care services only

Answer(s): A

Reveal Solution Next Question

QUESTION: 76

The following statements are about incentive programs used for providers. Select the answer choice containing the correct statement.

Risk pools based on aggregate provider performance eliminate problems associated with "free riders."
A hospital bonus pool is usually split between the health plan and the PCPs.
Bonus pools based on the performance of specific providers are usually easier to administer than those based on the performance of the plan as a whole.
For providers, withhold arrangements eliminate the risk of losing base income.

Answer(s): B

Reveal Solution Next Question

Free AHM-530 Exam Braindumps (page: 20)

QUESTION: 73

QUESTION: 74

QUESTION: 75

QUESTION: 76

AHM-530 Discussions & Posts