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Dr. Ahmad Shah and Dr. Shantelle Owen provide primary care services to Medicare+Choice enrollees of health plans under the following physician incentive plans:
Dr. Shah receives $40 per enrollee per month for providing primary care and an additional $10 per enrollee per month if the cost of referral services falls below a specified level
Dr. Owen receives $30 per enrollee per month for providing primary care and an additional $15 per enrollee per month if the cost of referral services falls below a specified level
The use of a physician incentive plan creates substantial risk for
With respect to contractual provisions related to provider-patient communications, nonsolicitation clauses prohibit providers from
In most health plan pharmacy networks, the cost component of the reimbursement formula is based on the average wholesale price (AWP). One true statement about the AWP for prescription drugs is that
One true statement about the Employee Retirement Income Security Act of 1974 (ERISA) is that:
The following statements are about Medicaid health plan entities. Select the answer choice containing the correct statement:
