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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Ronald

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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Ayesha

6 days ago

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

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Dan

7 days ago

I disagree, I believe the answer is A.

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Gennie

8 days ago

I think the answer is B.

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Simona

10 days 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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