AHIP Exam AHM-530 Topic 3 Question 92 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 92
Topic #: 3

To protect providers against business losses, many health plan-provider contracts include carve-out provisions to help providers manage financial risk. The following statements are examples of such provisions:

The Apex Health Plan carves out immunizations from PCP capitations. Apex compensates PCPs for immunizations on a case rate basis.

The Bengal Health Plan carves out behavioral healthcare services from the scope of PCP services because these services require specialized knowledge and skills that most PCPs do not possess.

From the answer choices below, select the response that best identifies the types of carve-outs used by Apex and Bengal.

AApex: disease-specific carve-out Bengal: specialty services carve-out

BApex: disease-specific carve-out Bengal: specific-service carve-out

CApex: specific-service carve-out Bengal: specialty services carve-out

DApex: specific-service carve-out Bengal: disease-specific carve-out

Show Suggested Answer

Suggested Answer: B

by Antonio at Jul 08, 2024, 01:10 AM

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Stefany

3 hours ago

This is a tricky one, but I think Option A is the way to go. Apex is doing a disease-specific carve-out for immunizations, and Bengal is doing a specialty services carve-out for behavioral healthcare.

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Mi

10 days ago

I'm leaning towards Option C. Apex is doing a specific-service carve-out for immunizations, and Bengal is doing a specialty services carve-out for behavioral healthcare.

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Dana

11 days ago

Option B seems to be the correct answer. The Apex Health Plan carves out immunizations, which is a specific service, and the Bengal Health Plan carves out behavioral healthcare services, which is a specialty service.

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Marilynn

12 days ago

I'm not sure, but I think the rationale is that Apex compensates PCPs for immunizations on a case rate basis, while Bengal requires specialized knowledge for behavioral healthcare services.

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Verona

16 days ago

I agree with Marshall. Apex carves out immunizations and Bengal carves out behavioral healthcare services.

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Marshall

17 days ago

I think the answer is A) Apex: disease-specific carve-out Bengal: specialty services carve-out.

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