AHIP Exam AHM-520 Topic 1 Question 74 Discussion

Actual exam question for AHIP's AHM-520 exam

Question #: 74
Topic #: 1

For each of its products, the Wisteria Health Plan monitors the provider reimbursement trend and the residual trend. One true statement about these trends is that

AThe provider reimbursement trend probably is more difficult for Wisteria to quantify than is the residual trend

BWisteria's residual trend is the difference between the total trend and the portion of the total trend caused by changes in Wisteria's provider reimbursement levels

CThe residual trend most likely has more impact on Wisteria's total trend than does the provider reimbursement trend

DAn example of a residual trend would be a 5% increase in the capitation rate paid to a PCP by Wisteria

Show Suggested Answer

Suggested Answer: D

by Josephine at Sep 03, 2023, 07:20 PM

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Levi

8 days ago

Wait, a 5% increase in the capitation rate is considered a residual trend? I thought that was just a straight-up provider reimbursement change. These insurance terms are starting to make my head spin!

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Carmela

9 days ago

I'm pretty sure the residual trend has a bigger impact on the overall trend. Those little things can really add up, you know?

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Laurel

13 days ago

Ah, I see. The residual trend is what's left over after accounting for the provider reimbursement changes. Sounds like a real brain-teaser to keep track of all those moving parts.

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Milly

15 days ago

The provider reimbursement trend is definitely more challenging to quantify. Wisteria must have a team of actuaries crunching the numbers 24/7 to stay on top of that!

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