Question 1

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:

Options :

A : Referral circle capitation

B : Risk pod capitation

C : Contact capitation

D : Retrospective reimbursement capitation

Answer: C

Question 2

A health plan's costs can be classified as committed costs or discretionary costs. An example of a discretionary cost for a health plan is the cost of its:

Options :

A : Facilities

B : Executive salaries

C : Employee training

D : Equipment

Answer: A

Question 3

If the Ascot health plan's accountants follow the going-concern concept under GAAP, then these accountants most likely:

Options :

A : Assume that Ascot will pay its liabilities immediately or in full during the current accounting period

B : Defer certain costs that Ascot has incurred, unless these costs contribute to the health plan-s future earnings

C : Assume that Ascot is not about to be liquidated, unless there is evidence to the contrary

D : Value Ascot-s assets more conservatively than they would under SAP

Answer: C

Question 4

In a fee-for-service (FFS) reimbursement method, providers are paid per treatment or per service that they provide.

One typical benefit of FFS reimbursement is that it:

Options :

A : Is highly effective in preventing excessive services that take the form of churning, unbundling, and upcoding

B : Provides physicians who attempt to control costs with a higher rate of compensation than is provided to physicians who make the effort to control costs

C : Is relatively easy to initiate, especially in markets where managed care penetration is low

D : Guards against the practice of defensive medicine

Answer: B

Question 5

The Fairway health plan is a for-profit health plan that issues stock. The following data was taken from Fairway's financial statements:

Current assets.....$5,000,000 -

Total assets.....$6,000,000 -

Current liabilities.....$2,500,000

Total liabilities.....$3,600,000

Stockholders' equity.....$2,400,000

Fairway's total revenues for the previous financial period were $7,200,000, and its net income for that period was $180,000.

For the previous financial period, Fairway's net profit margin was:

Options :

A : 2.50%

B : 3.00%

C : 3.60%

D : 7.50%

Answer: A