AHIP Exam AHM-530 Topic 4 Question 95 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 95
Topic #: 4

The provider contract that Dr. Huang Kwan has with the Poplar Health Plan includes a typical scope of services provision. The medical service that Dr. Kwan provided to Alice Meyer, a Poplar plan member, is included in the scope of services. The following statement(s) can correctly be made about this particular medical service:

ADr. Kwan most likely was required to seek authorization from Poplar before performing this particular service.

BDr. Kwan most likely was paid on a FFS basis for providing this service.

CBoth A and B

DA only

EB only

FNeither A nor B

Show Suggested Answer

Suggested Answer: B

by Yvette at Aug 25, 2024, 10:55 PM

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Maryann

1 months ago

This question is about as clear as mud. I'm just going to go with option E and hope for the best. Maybe I'll get lucky and the exam grader will have a good sense of humor, and they'll give me partial credit for the 'Dr. Kwan the Juggling Maverick' joke I just came up with.

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Pearly

20 days ago

Yeah, I'm going with option E too.

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Angella

24 days ago

I agree, Dr. Kwan was most likely paid on a FFS basis.

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Honey

26 days ago

I think option E is the best choice here.

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Erick

2 months ago

Option B, all the way. Dr. Kwan is a true entrepreneur, and he's probably billing Poplar on a FFS basis for this service. I bet he's got a secret side hustle going on, too - maybe he's moonlighting as a professional juggler or something.

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Lore

2 months ago

I'm going to have to go with option D - A only. I mean, it just makes sense that Dr. Kwan would need to get the greenlight from Poplar before providing this service. He's not about to rock the boat and risk losing that sweet, sweet Poplar cash.

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Cordelia

9 days ago

Definitely, can't risk losing that Poplar contract.

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Helga

10 days ago

Yeah, it's better to play it safe and follow the rules.

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Coral

30 days ago

I agree, Dr. Kwan probably had to get approval from Poplar before doing anything.

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Ezekiel

2 months ago

Option F, definitely. Dr. Kwan is a maverick, and he's not going to let some pesky contract stop him from doing what he thinks is best for his patients. I bet he just laughed in the face of Poplar's authorization requirements.

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Belen

2 months ago

Hmm, this looks like a tricky one. I'm going to go with option C - both A and B seem plausible based on the typical scope of services provision. After all, who wants to get on the bad side of the Poplar Health Plan?

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