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AHM-520 Health Plan Finance and Risk Management is now Stable and With Pass Result | Test Your Knowledge for Free

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AHM-520 Practice Questions

Health Plan Finance and Risk Management

Last Update 1 day ago
Total Questions : 215

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Question # 31

Juan Ramirez, a licensed social worker, and Dr. Laura Lui, a licensed psychiatrist, are under contract to the Peninsula Health Plan. Peninsula has contracted with CMS to provide services to Medicare and Medicaid beneficiaries. Both Mr. Ramirez and Dr. Lui provide the same type of counseling services to Peninsula's enrollees. With respect to amendments made to the Balanced Budget Act (BBA) of 1997 that impact provider reimbursement, the amount by which Peninsula will reimburse Mr. Ramirez will be equal to:

Options:

A.  

50% of Dr. Lui's reimbursement

B.  

75% of Dr. Lui's reimbursement

C.  

90% of Dr. Lui's reimbursement

D.  

100% of Dr. Lui's reimbursement

Discussion 0
Question # 32

In evaluating the claims experience during a given rating period of the Lucky Company, the Calaway Health Plan determined that the claims incurred by Lucky were lower than Calaway anticipated when it established Lucky’s premium rate for the rating period. Calaway, therefore, refunded a portion of Lucky’s premium to reflect the better-than-anticipated claims experience. This rating method is known as:

Options:

A.  

durational rating

B.  

retrospective experience rating

C.  

blended rating

D.  

prospective experience rating

Discussion 0
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