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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
Suggested Answer: B
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36 comments · newest first
VI
Viola
11 months ago
I thought it was only A that applied. Confusing!
JU
Julianna
11 months ago
Both A and B are correct under federal law.
JO
Jonell
12 months ago
Wait, are we sure about the stop-loss coverage? Sounds too good to be true.
MI
Minna
12 months ago
Totally agree, that 10% threshold is a big deal!
SH
Shayne
1 year ago
A provider is at substantial risk if they can lose over 10% of their reimbursement.
FR
Franchesca
1 year ago
I recall that both A and B have specific implications under federal law, but I can't remember if they both need to be true for the answer to be "Both A and B."
LE
Leota
1 year ago
I’m a bit confused about the 10% threshold mentioned in A. Does that mean any risk above that automatically qualifies as "substantial"?
RO
Rosalind
1 year ago
I think I came across a similar question in practice that emphasized the stop-loss coverage requirement. I feel like B might be the right choice.
JO
Jody
1 year ago
I remember studying the definitions of "substantial financial risk," but I'm not entirely sure if it applies to both A and B.
PE
Pearlene
1 year ago
Hmm, this is a tricky one. I'm going to re-read the question a few times to make sure I'm not missing any important details before selecting an answer.
CY
Cyndy
1 year ago
I've got this! The key is understanding what constitutes "substantial financial risk" for providers. Based on the question, that seems to be the main focus, so I'll start there in formulating my answer.
LE
Leoma
1 year ago
I'm a little confused by the wording of the answer choices. I need to carefully read through each one to determine which one best matches the information provided in the question.
EZ
Ezekiel
1 year ago
This question seems straightforward, but I want to make sure I understand the key details before answering.
GA
Gayla
1 year ago
Okay, let me think this through. The question is asking about the relationship between Medicare/Medicaid contracting health plans and providers who are at "substantial financial risk." I'll need to focus on the specific requirements under federal law.
DE
Dell
1 year ago
Wait, is this question sponsored by the Department of Obscure Healthcare Regulations? I'm in trouble...
EL
Elliott
1 year ago
Yeah, it's important to protect providers who are taking on significant financial risk in their contracts.
DA
Danilo
1 year ago
I agree, it makes sense that Medicare- or Medicaid-contracting health plans would have to provide stop-loss coverage to providers at substantial financial risk.
KA
Kathrine
1 year ago
I think the answer is A) Both A and B.
CH
Chan
2 years ago
I bet the person who wrote this question is sitting back, sipping their coffee, and chuckling at the poor souls trying to decipher it.
KA
Karol
1 year ago
D) Neither A nor B
LO
Lonna
1 year ago
C) B only
VA
Vanna
1 year ago
A) Both A and B
TO
Tomas
2 years ago
Hold on, are they really asking me to memorize the specific percentages and requirements for stop-loss coverage? That seems a bit excessive.
CH
Cherry
1 year ago
It's always good to stay informed about the regulations to avoid any issues.
GL
Glenn
1 year ago
I think it's important to know the details to ensure compliance.
EL
Elenora
1 year ago
I agree, it does seem like a lot to remember.
MA
Malcolm
2 years ago
Hmm, I think I need to brush up on my federal healthcare regulations before tackling this one. All these acronyms and terms are making my head spin!
LU
Lucina
2 years ago
That's a good point, but I still think both A and B are necessary to ensure providers are adequately protected.
EA
Earnestine
2 years ago
Wow, this question is tricky! I'm not sure if I fully understand the nuances of 'substantial financial risk' for providers under Medicare and Medicaid.
RY
Ryann
2 years ago
User 2
JU
Juliana
2 years ago
User 1
CA
Carissa
2 years ago
I disagree, I believe the answer is C. Stop-loss coverage is crucial for providers at substantial financial risk.
LU
Lucina
2 years ago
I think the answer is A, because both A and B are important for protecting providers.
AL
Alesia
2 years ago
That's a good point, but I still think both A and B are necessary to ensure providers are adequately protected.
NI
Nickolas
2 years ago
I disagree, I believe the answer is C because stop-loss coverage is crucial for providers at substantial financial risk.
AL
Alesia
2 years ago
I think the answer is A because both A and B are important to protect providers.