AHIP Exam AHM-530 Topic 6 Question 86 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 86
Topic #: 6

Following statements are about accreditation of health plans:

AThe National Committee for Quality Assurance (NCQA) serves as the primary accrediting agency for most health maintenance organizations (HMOs).

BThe Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has developed standards that can be used for the accreditation of hospitals, but not for the accreditation of health plan provider networks or health plan plans.

CStates are required to adopt the model standards developed by the National Association of Insurance Commissioners (NAIC), an organization of state insurance regulators that develops standards to promote uniformity in insurance regulations.

DAccreditation is an evaluative process in which a health plan undergoes an examination of its operating procedures to determine whether the procedures meet designated criteria as defined by the federal government or by the state governments.

Show Suggested Answer

Suggested Answer: D

by Tyra at Apr 28, 2024, 12:32 AM

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Cathern

1 months ago

This is a tricky one! I'm pretty sure NCQA is the main accreditor for HMOs, but the JCAHO part is throwing me off a bit. I'll have to double-check the details on that.

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Vicky

5 days ago

I'm not sure about JCAHO's role in accrediting health plan provider networks though.

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Elmer

9 days ago

Yeah, NCQA is definitely a big player in the accreditation of health plans.

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Ivette

18 days ago

I think you're right about NCQA being the primary accrediting agency for HMOs.

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Margart

1 months ago

Haha, accreditation, the bane of every health plan's existence! If only they had a magic 8-ball to predict the surveyors' questions. Jokes aside, I think A, C, and D are the winners here.

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Harrison

2 months ago

I'm a bit confused by C. I thought states had flexibility in their insurance regulations, not a requirement to adopt NAIC model standards. Hmm, maybe I should review that one again.

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Margot

User 3: Maybe it's to ensure some level of uniformity across different states.

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Johana

4 days ago

User 2: Yeah, but they still need to follow certain model standards set by NAIC.

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Alease

5 days ago

User 1: I think states do have some flexibility in their insurance regulations.

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Matthew

2 months ago

B seems incorrect since JCAHO does accredit health plan provider networks and plans, not just hospitals. I'm leaning towards A, C, and D as the right answers.

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Veronika

6 days ago

Accreditation involves examining operating procedures to meet specific criteria.

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Selma

9 days ago

States are required to adopt model standards from NAIC for uniformity in regulations.

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Glory

30 days ago

NCQA is definitely a primary accrediting agency for most HMOs.

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Sheron

2 months ago

I agree, JCAHO does accredit health plan provider networks and plans.

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Dannie

2 months ago

I believe D is also important because accreditation ensures that health plans meet specific criteria.

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Tijuana

2 months ago

I agree with you, Ulysses. NCQA is definitely a major accrediting agency for HMOs.

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Julio

2 months ago

I think A and D are the correct statements. NCQA is the primary accrediting agency for HMOs, and accreditation involves an evaluation of a health plan's procedures to determine if they meet the defined criteria.

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