Governance and Regulation: AHM-510

Solvency standards for Medicare provider-sponsored organizations (PSOs) are divided into three parts: (1) the initial stage, (2) the ongoing stage, and (3) insolvency. In the initial stage, prior to CMS approval, a Medicare PSO typically must have a minimum net worth of

A. $750,000

B. $1,000,000

C. $1,500,000

D. $2,000,000

In 1994, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) revised their 1993 healthcare-specific antitrust guidelines to include analytical principles relating to multiprovider networks. Under the new guidelines, the regulatory agencies will use the rule ofreason to analyze joint pricing activities by competitors in physician or multiprovider networks only if

A. Provider integration under the network is likely to produce significant efficiencies that benefit consumers

B. The providers in a network share substantial financial risk

C. The combining of providers into a joint venture enables the providers to offer a new product

D. All of the above

While traditional workers' compensation laws have restricted the use of managed care techniques, many states now allow managed workers' compensation. One common characteristic of managed workers' compensation plans is that they

A. Discourage injured employees from returning to work until they are able to assume all the duties of their jobs

B. Use low copayments to encourage employees to choose preferred providers

C. Cover an employee's medical costs, but they do not provide coverage for lost wages

D. Rely on total disability management to control indemnity benefits