AHIP Exam AHM-250 Topic 5 Question 76 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 76
Topic #: 5

Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billi

Aprevent Dr. Ware from requiring a Riverside member to pay any coinsurance, copayment, or deductibles that the member would normally pay under Riverside's plan

Brequire Dr. Ware to accept the amount that Riverside pays for medical services as payment in full and not to bill plan members for additional amounts

Cprevent Dr. Ware from seeking compensation from patients if Riverside fails to compensate him because of the MCO's insolvency

Dprevent Dr. Ware from billing a Riverside member for medical services that are not included in Riverside's plan

Show Suggested Answer

Suggested Answer: A

by Tonette at Oct 20, 2023, 04:41 AM

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Kelvin

1 months ago

I'm going with B. It makes sense that the no-balance billing clause would require Dr. Ware to accept Riverside's payment as full payment, no matter how low it is. *chuckles* Gotta love those provider contracts!

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Teresita

2 days ago

Yeah, it's important for providers to stick to the terms of their contracts. Keeps everything fair for everyone involved.

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Amalia

19 days ago

I agree, B does seem like the most logical choice. No surprises for the patients!

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Chau

1 months ago

D is the correct answer. The no-balance billing clause should stop Dr. Ware from charging the member for services that aren't part of Riverside's plan coverage.

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France

26 days ago

I agree, D is the correct answer. Dr. Ware cannot bill a Riverside member for services not covered by the plan.

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Felix

1 months ago

Option C seems like the best choice. The no-balance billing clause should stop Dr. Ware from billing the member if Riverside doesn't pay him due to their financial troubles.

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Fausto

1 days ago

It's important for Dr. Ware to be protected in case Riverside fails to compensate him.

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Raina

13 days ago

I agree, option C is the most logical choice.

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Christa

2 months ago

I think A is the right answer. The no-balance billing clause should prevent Dr. Ware from making the member pay any cost-sharing like coinsurance or deductibles that Riverside's plan covers.

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Donette

18 days ago

Yes, that's right. Dr. Ware should not be able to require the member to pay anything beyond what Riverside covers.

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Ty

1 months ago

I agree, option A seems to be the correct choice. It would protect the member from having to pay any additional costs.

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Talia

2 months ago

The correct answer is B. The no-balance billing clause in Dr. Ware's contract requires him to accept Riverside's payment as full compensation and not bill the member for additional amounts. This protects the member from unexpected costs.

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