AHIP Exam AHM-520 Topic 6 Question 97 Discussion

Actual exam question for AHIP's AHM-520 exam

Question #: 97
Topic #: 6

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

ABoth A and B

BA only

CB only

DNeither A nor B

Show Suggested Answer

Suggested Answer: B

by Bulah at Sep 13, 2024, 02:00 PM

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Malcolm

4 hours 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!

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Lucina

8 days ago

That's a good point, but I still think both A and B are necessary to ensure providers are adequately protected.

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Earnestine

12 days 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.

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Carissa

13 days ago

I disagree, I believe the answer is C. Stop-loss coverage is crucial for providers at substantial financial risk.

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Lucina

16 days ago

I think the answer is A, because both A and B are important for protecting providers.

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Alesia

18 days ago

That's a good point, but I still think both A and B are necessary to ensure providers are adequately protected.

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Nickolas

23 days ago

I disagree, I believe the answer is C because stop-loss coverage is crucial for providers at substantial financial risk.

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Alesia

25 days ago

I think the answer is A because both A and B are important to protect providers.

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