Reconciliation Is the Process by Which a Health Plan Assesses

question 86

Multiple Choice

Reconciliation is the process by which a health plan assesses providers' performance relative to contractual terms and reimbursement. With regard to this process, it can correctly be stated that

• A) Areconciliation typically includes payment to the providers of any withholds or bonuses due to them
• B) Ahealth plan typically should conduct a reconciliation immediately after the evaluation period 14 has ended
• C) Most agreements between health plans and providers require reconciliations to be performed quarterly
• D) Ahealth plan typically should not conduct reconciliation for a provider until the plan has received all claims or other documentation of services that the physician provided during the evaluation period

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Definitions:

Gouging

The process of making grooves or marks in a surface, often related to glacial activity in geological contexts.

Cirque

An open-sided, bowl-shaped depression formed in a mountain, commonly at the head of a glacial valley; produced by erosion of a glacier.

Depression

A geological formation resulting from the sinking of the Earth's surface, forming a bowl-like or flat area lower than the surrounding ground.

Valley

An elongated lowland between ranges of mountains or hills, often having a river or stream running along the bottom.