AHIP Exam AHM-530 Topic 6 Question 101 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 101
Topic #: 6

The BBA of 1997 specifies the ways in which a Medicare+Choice plan can establish and use provider networks. A Medicare+Choice plan that operates as a private fee for service (PFFS) plan is allowed to

Alimit the size of its network to the number of providers necessary to meet the needs of its enrollees

Brequire providers to accept as payment in full an amount no greater than 115% of the Medicare payment rate

Crefuse payment to non-network providers who submit claims for Medicare-covered expenses

Dshift all risk for Medicare-covered services to network providers

Show Suggested Answer

Suggested Answer: A

by Bernadine at Sep 19, 2024, 07:59 AM

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Mitsue

29 days ago

Option B is the way to go, folks. Limiting provider payments to 115% of the Medicare rate - that's the key thing PFFS plans can do according to the BBA. Now excuse me while I go practice my 'haggling with providers' skills.

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Louvenia

14 days ago

It's all about negotiating those payment rates with providers.

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Odelia

15 days ago

I agree, option B is definitely a game changer for PFFS plans.

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Ira

1 months ago

Alright, let's see here. I'm going to have to go with option B. It just makes the most sense when it comes to PFFS plan requirements under the BBA of '97. Solid choice, if I do say so myself.

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Cletus

1 months ago

Haha, imagine if PFFS plans could just shift all the risk to the providers. That would be like playing 'hot potato' with Medicare-covered services! But I digress, I'd go with option B.

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Weldon

23 hours ago

User 2: I agree, it would definitely make things interesting.

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Bettina

19 days ago

User 1: Haha, that would be quite the game of 'hot potato' with Medicare-covered services!

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Ronald

2 months ago

Hmm, this is a tricky one. I'm leaning towards option C, as PFFS plans can refuse payment to non-network providers. Gotta watch out for those sneaky non-network docs!

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Donette

1 months ago

Definitely, being aware of the rules around provider networks is crucial when choosing a Medicare+Choice plan.

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Colby

1 months ago

I agree, it's important to understand how PFFS plans handle payments to non-network providers.

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Lacey

1 months ago

I think you're onto something with option C. Non-network providers can be tricky.

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Ayesha

2 months ago

I'm not sure, but I think the answer might be C.

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Dan

2 months ago

I disagree, I believe the answer is A.

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Gennie

2 months ago

I think the answer is B.

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Simona

2 months ago

I see your point, but I still think A is the correct answer because it makes sense for the plan to limit the size of its network to meet the needs of its enrollees.

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