AHIP Health Plan Finance and Risk Management AHM-520 Question # 93 Topic 3 Discussion
AHM-520 Exam Topic 3 Question 93 Discussion:
Question #: 93
Topic #: 3
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
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