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AHIP AHM-530 Exam - Topic 2 Question 21 Discussion

Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:
D) Unbundling
A) Upcoding
B) A wrap-around
C) Churning

AHIP AHM-530 Exam - Topic 2 Question 21 Discussion

Actual exam question for AHIP's AHM-530 exam
Question #: 21
Topic #: 2
[All AHM-530 Questions]

Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:

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Suggested Answer: D

by Kattie at May 10, 2022, 01:59 AM

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Lina
11 months ago
Nope, this is classic unbundling, no doubt about it.
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Nana
11 months ago
I thought upcoding was the bigger issue here?
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Anglea
11 months ago
Wait, can you really get in trouble for that?
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Filiberto
11 months ago
Totally agree, she's trying to game the system.
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Selma
11 months ago
That's definitely unbundling.
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Lashanda
12 months ago
I'm a bit confused by this question. I'll need to review my notes on the Control process blade to make sure I have a solid understanding of its responsibilities.
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Fallon
12 months ago
Hmm, I'm a little confused by the wording on some of these options. I'll need to review the live migration process again to make sure I understand which steps are actually required here.
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Stevie
12 months ago
The question is asking for two characteristics, so I'll need to make sure I select the two most relevant options. Let me think this through step-by-step.
upvoted 0 times
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