AHIP AHM-520 Exam - Topic 2 Question 107 Discussion

Actual exam question for AHIP's AHM-520 exam

Question #: 107
Topic #: 2

The following statements are about various reimbursement arrangements that health plans have with hospitals. Select the answer choice containing the correct statement.

AA sliding scale per-diem charges arrangement differs from a sliding scale discount on charges arrangement in that only a sliding scale per-diem charges arrangement is based on total volume of admissions and outpatient procedures.

BUnder a typical reimbursement arrangement that is based on diagnosis related groups (DRGs), if the payment amount is fixed on the basis of diagnosis, then any reduction in costs resulting from a reduction in days will go to the health plan rather than to the hospital.

CA negotiated straight per-diem charge requires payment of a single charge for a day in the hospital, regardless of any actual charges or costs incurred during the hospital stay.

DA straight discount on charges arrangement is the most common reimbursement method in markets with high levels of health plans.

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Suggested Answer: A

by Viva at Feb 11, 2025, 02:17 PM

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Dominque

4 months ago

I think A and B are both valid, but I lean towards B.

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Elli

4 months ago

Wait, is D really the most common? That’s surprising!

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Hortencia

4 months ago

C sounds a bit off to me, how can they charge a flat rate?

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Lashanda

4 months ago

Totally agree, B seems spot on!

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Na

5 months ago

A sliding scale per-diem is all about volume, right?

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Candra

5 months ago

I thought straight discounts were common, but I’m not sure if they’re the most common method in high health plan markets.

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Dustin

5 months ago

I feel like option B makes sense, but I’m a bit confused about how the fixed payment interacts with the hospital's costs.

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Carman

5 months ago

I think I came across a similar question about per-diem charges, but I can't recall the specifics of how sliding scales differ.

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Lashon

5 months ago

I remember studying about DRGs and how they work, but I'm not entirely sure if the payment really goes to the health plan if costs are reduced.

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Mireya

5 months ago

This is a tricky one, but I'm going to take my time, analyze each option, and choose the statement that I'm most certain is accurate.

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Virgie

5 months ago

I've got a good handle on these reimbursement models from my studies. I think I can confidently select the correct answer here.

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Laurel

5 months ago

I'm a little confused by the wording on the sliding scale options. I'll need to re-read that part carefully to make sure I grasp the difference.

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Timothy

5 months ago

Okay, let me think through this step-by-step. The key is to focus on the distinctions between the arrangements, like whether the payment is based on total volume or a fixed amount per day.

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Johanna

6 months ago

This question seems straightforward, but I want to make sure I understand the differences between the reimbursement arrangements before selecting an answer.

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Cornell

10 months ago

Wait, they actually pay hospitals based on diagnoses? I thought they just threw darts at a board to determine the reimbursement rates!

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Estrella

10 months ago

Ah, the joys of health care reimbursement! I'll go with B, since it seems to align with the concept of DRGs and incentives for the hospital.

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Brittney

10 months ago

I'm going with D. In markets with high competition, health plans would likely negotiate discounted charges with hospitals to keep costs down. Sounds like the most common arrangement to me.

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Mona

9 months ago

For sure. Keeping costs down benefits everyone involved.

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Tina

9 months ago

Definitely. It's a win-win situation for both parties.

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Vannessa

9 months ago

Yeah, I agree. It's important for health plans to keep expenses low.

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Tamesha

9 months ago

I think D makes sense. It's all about negotiating costs in competitive markets.

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Man

10 months ago

Hmm, this is a tricky one. I'm leaning towards C, since a negotiated straight per-diem charge seems like a simple and straightforward way to reimburse hospitals.

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Douglass

9 months ago

Yeah, it makes sense to just pay a single charge for each day in the hospital.

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Yuonne

10 months ago

I agree, a negotiated straight per-diem charge does seem like an easy way to handle reimbursement.

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Val

10 months ago

I think C is correct. It does sound simple and straightforward.

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Julianna

11 months ago

I think option B is the correct answer. Under a DRG-based reimbursement, the hospital is paid a fixed amount based on the diagnosis, so any savings from reduced length of stay go to the health plan, not the hospital.

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