Exam 3: Health Plan Finance and Risk Management

This concept, which is an extension of the going-concern concept, holds that the value of an asset that a company reports in its accounting records should be the asset's historical cost, not its current market value. Although this concept offers objectivity and reliability, it may lack relevance, particularly for assets held for a long period of time. From the following answer choices, choose the name of the accounting concept that matches the description.

The Marble Health Plan sets aside a PMPM amount for each specialty. When a PCP in Marble's provider network refers a Marble plan member to a specialist and the specialist provides medical services to the member, the specialist begins to receive a share of those funds on a monthly basis. Marble determines the monthly payment for each specialist by dividing the number of active patients for that specialty by the total specialty pool for that month. This form of payment, which is similar to a case rate, is known as

One true statement about a health plan's underwriting margin is that

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.

The Poplar Company and a Blue Cross/Blue Shield organization have contracted to provide a typical fully funded health plan for Poplar's employees. One true statement about this health plan for Poplar's employees is that

In addition to the credentialing activities that a health plan performs when initially accepting a provider into its network, the health plan must also perform recredentialing of the same providers on an ongoing basis. Many of the same activities are per

With regard to the major risk factors associated with group underwriting, it can correctly be stated that, typically,

The following statements are about the new methodology authorized under the Balanced Budget Act of 1997 (BBA) for payments by the Centers for Medicaid & Medicare Services (CMS) to Medicare-contracting health plans.Select the answer choice containing the correct statement.

In the following sections, we will describe some of the measures health plans use to evaluate the quality of the services and healthcare they offer their members. Which of the following is the best description of what a 'Process measure' evaluates?

From the following choices, choose the definition that best matches the term health risk assessment (HRA)

Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr. Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

As part of its utilization management (UM) system, the Poplar MCO uses a process known as case management. The following statements describe individuals who are Poplar plan members: -Brad Van Note, age 28, is taking many different, costly medications for

A health plan may use one of several types of community rating methods to set premiums for a health plan. The following statements are about community rating. Select the answer choice containing the correct statement.

In large health plans, management functions such as provider recruiting, credentialing, contracting, provider service, and performance management for providers are typically the responsibility of the

Because many patients with behavioral health disorders do not require round-the-clock nursing care and supervision, behavioral healthcare services can be delivered effectively in a variety of settings. For example, post-acute care for behavioral health dictate that staff be onsite at all times. What is needed for this type of care?

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

The following statements are about pure risk and speculative risk-two kinds of risk that both businesses and individuals experience. Select the answer choice containing the correct statement.