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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Yuette

1 months ago

Okay, let me get this straight - Apex is carving out shots, and Bengal is carving out mental health? Sounds like they're trying to create a bunch of un-vaccinated, mentally unstable patients. What a recipe for success!

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Jules

2 days ago

And Bengal is carving out behavioral healthcare services because they require specialized knowledge and skills, making it a specialty services carve-out.

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Lenna

3 days ago

That's correct! Apex is compensating PCPs for immunizations on a case rate basis, which falls under disease-specific carve-outs.

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Ronald

5 days ago

I think Apex is focusing on disease-specific carve-outs, while Bengal is focusing on specialty services carve-outs.

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Kattie

1 months ago

Wait, they're carving out immunizations? I thought that was the whole point of going to the doctor in the first place! This exam is making my head spin like a carousel.

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Jaclyn

1 months ago

Option D has got to be the answer, right? Apex is doing a specific-service carve-out for immunizations, and Bengal is doing a disease-specific carve-out for behavioral healthcare. Easy peasy!

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Justine

3 days ago

Yes, you're correct! Apex is doing a specific-service carve-out for immunizations, and Bengal is doing a disease-specific carve-out for behavioral healthcare.

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Stefany

2 months 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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Alida

7 days ago

Yes, Option A makes sense. Apex is using disease-specific carve-outs and Bengal is using specialty services carve-outs to protect providers against business losses.

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Alexis

9 days ago

I think you're right. Apex is carving out immunizations based on diseases, while Bengal is carving out specialty services like behavioral healthcare.

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Jin

25 days ago

I agree, Option A seems to be the best choice. Apex is focusing on disease-specific carve-outs and Bengal is focusing on specialty services carve-outs.

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Mi

2 months 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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Paulina

1 months ago

I agree. 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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Casandra

1 months ago

I think Option C makes sense. Apex is carving out specific services like immunizations, while Bengal is focusing on specialty services like behavioral healthcare.

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Dana

2 months 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

2 months 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

2 months ago

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

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Marshall

2 months ago

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

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