AHIP Exam AHM-530 Topic 2 Question 77 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 77
Topic #: 2

As an authorized Medicare+Choice plan, the Brightwell HMO must satisfy CMS requirements regulating access to covered services. In order to ensure that its network provides adequate access, Brightwell must

AAllow enrollees to determine whether they will receive primary care from a physician, nurse practitioner, or other qualified network provider

BBase a provider's participation in the network, reimbursement, and indemnification levels on the provider's license or certification

CDefine its service area according to community patterns of care

DRequire enrollees to obtain prior authorization for all emergency or urgently needed services

Show Suggested Answer

Suggested Answer: A

by Cecilia at Nov 22, 2023, 04:33 PM

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Sharan

2 months ago

Option A sounds like it gives a lot of freedom to the enrollees, but I'm not sure that's the best way to ensure adequate access. Shouldn't Brightwell be the one making those decisions?

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Amina

15 days ago

User 3: But wouldn't Brightwell know best which providers are most qualified to meet the needs of their enrollees?

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Meghann

18 days ago

User 4: Yeah, having requirements based on licenses makes sense.

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Amber

18 days ago

User 3: Option B seems like it would ensure providers meet certain standards.

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Lisha

19 days ago

User 2: I agree, having the choice could lead to better outcomes for the enrollees.

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Jessenia

20 days ago

User 2: I agree, but maybe Brightwell should have more control over access.

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Timothy

23 days ago

User 1: Option A sounds good, it lets enrollees choose their provider.

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Trinidad

1 months ago

User 1: Option A does give a lot of freedom to enrollees, but it could also help ensure they receive care from the most appropriate provider.

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Eden

2 months ago

Haha, Option D is a classic trick question! Requiring prior authorization for emergency services would be a big no-no.

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Antonette

2 months ago

But C makes more sense because it ensures access based on community patterns of care.

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Dell

2 months ago

I disagree, I believe the answer is A.

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Ciara

2 months ago

I'm not sure about Option B. Basing provider participation on their license or certification doesn't necessarily guarantee adequate access, does it?

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Maryln

1 months ago

User 4: Option C could also be important, defining service areas based on community patterns of care can help ensure access for enrollees.

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Justine

1 months ago

User 3: I'm not sure about Option B either, it might not be the best way to guarantee access to covered services.

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Florencia

2 months ago

User 2: I agree, having options for primary care providers can help ensure access to necessary services.

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Diego

2 months ago

User 1: I think Option A is important because it gives enrollees choices for their primary care provider.

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Charolette

2 months ago

Option C seems like the most logical choice. Defining the service area according to community patterns of care ensures that the network is accessible to the target population.

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Antonette

2 months ago

I think the answer is C.

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