The Method That the Autumn Health Plan Uses for Reimbursing

question 100

Multiple Choice

The method that the Autumn Health Plan uses for reimbursing dermatologists in its provider network involves paying them out of a fixed pool of funds that is actuarially determined for this specialty. The amount of funds that Autumn allocates to dermatologists is based on utilization and costs of services for that discipline. Under this reimbursement method, a dermatologist who is under contract to Autumn accumulates one point for each new referral made to the specialist by Autumn's PCPs. If the referral is classified as complicated, then the dermatologist receives 1.5 points. The value of Autumn's dermatology services fund for the first quarter was $15,000. During the quarter, Autumn's PCPs made 90 referrals, and 20 of these referrals were classified as complicated. In determining the first quarter payment to dermatologists, Autumn would accurately calculate the value of each referral point to be

• A) $111.11
• B) $125.00
• C) $150.00
• D) $166.67

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Definitions:

Bond Price

The amount of money for which a bond is bought or sold in the market, influenced by interest rates, credit quality, and maturity period.

YTM

Yield to Maturity (YTM) is the total return anticipated on a bond if the bond is held until its maturity date, accounting for its current market price, interest payments, and time value.

AAA Credit Rating

The highest credit rating assigned to a borrower's debt instruments by credit rating agencies, indicating an extremely low risk of default.

A Credit Rating

This is an evaluation of the credit risk of a prospective debtor, predicting their ability to pay back the debt and an implicit forecast of the likelihood of the debtor defaulting.