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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Dell

1 months ago

Wait, is this question sponsored by the Department of Obscure Healthcare Regulations? I'm in trouble...

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Kathrine

14 days ago

I think the answer is A) Both A and B.

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Chan

1 months ago

I bet the person who wrote this question is sitting back, sipping their coffee, and chuckling at the poor souls trying to decipher it.

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Karol

23 days ago

D) Neither A nor B

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Lonna

24 days ago

C) B only

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Vanna

1 months ago

A) Both A and B

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Tomas

2 months ago

Hold on, are they really asking me to memorize the specific percentages and requirements for stop-loss coverage? That seems a bit excessive.

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Cherry

13 days ago

It's always good to stay informed about the regulations to avoid any issues.

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Glenn

1 months ago

I think it's important to know the details to ensure compliance.

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Elenora

1 months ago

I agree, it does seem like a lot to remember.

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Malcolm

2 months 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

2 months 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

2 months 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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