AHIP Exam AHM-250 Topic 5 Question 76 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 76
Topic #: 5

Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billi

Aprevent Dr. Ware from requiring a Riverside member to pay any coinsurance, copayment, or deductibles that the member would normally pay under Riverside's plan

Brequire Dr. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts

Cprevent Dr. Ware from seeking compensation from patients if Riverside fails to compensate him because of the MCO's insolvency

Dprevent Dr. Ware from billing a Riverside member for medical services that are not included in Riverside's plan

Show Suggested Answer

Suggested Answer: A

by Tonette at Oct 20, 2023, 04:41 AM

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Felix

3 days ago

Option C seems like the best choice. The no-balance billing clause should stop Dr. Ware from billing the member if Riverside doesn't pay him due to their financial troubles.

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Christa

12 days ago

I think A is the right answer. The no-balance billing clause should prevent Dr. Ware from making the member pay any cost-sharing like coinsurance or deductibles that Riverside's plan covers.

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Talia

14 days ago

The correct answer is B. The no-balance billing clause in Dr. Ware's contract requires him to accept Riverside's payment as full compensation and not bill the member for additional amounts. This protects the member from unexpected costs.

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