AHIP AHM-530 Exam - Topic 4 Question 95 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 95
Topic #: 4

The provider contract that Dr. Huang Kwan has with the Poplar Health Plan includes a typical scope of services provision. The medical service that Dr. Kwan provided to Alice Meyer, a Poplar plan member, is included in the scope of services. The following statement(s) can correctly be made about this particular medical service:

ADr. Kwan most likely was required to seek authorization from Poplar before performing this particular service.

BDr. Kwan most likely was paid on a FFS basis for providing this service.

CBoth A and B

DA only

EB only

FNeither A nor B

Show Suggested Answer

Suggested Answer: B

by Yvette at Aug 25, 2024, 10:55 PM

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Moon

4 months ago

I doubt they needed authorization for that service.

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Bulah

4 months ago

Totally agree with both A and B!

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Royal

4 months ago

Wait, are we sure about A? Sounds off.

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Shaniqua

4 months ago

I think B is more accurate, FFS is standard.

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Laurene

5 months ago

A seems likely, authorization is common.

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Loren

5 months ago

I’m leaning towards A only because it seems like authorization is a common requirement, but I’m not completely confident.

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Laura

5 months ago

I feel like I've seen a similar question before where both A and B were correct, but I can't recall the specifics.

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Elke

5 months ago

I think Dr. Kwan might have been paid on a fee-for-service basis, but I need to double-check what that means in this context.

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Charlene

5 months ago

I remember discussing how authorization is often required for certain services, but I'm not sure if it's always the case.

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Ronny

5 months ago

Hmm, I'm not sure about this one. The wording is a bit tricky. I'll have to think it through carefully before selecting an answer.

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Halina

5 months ago

I'm pretty confident that the correct answer is C - both A and B. The scope of services provision suggests that authorization was not required, but the fee-for-service payment model is the more likely scenario.

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Alana

5 months ago

I'm a little confused by the wording here. Does the "scope of services" mean that Dr. Kwan was required to get authorization before providing the service? Or does it mean he was paid on a fee-for-service basis?

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Leontine

5 months ago

Hmm, this question seems pretty straightforward. I think the key is to focus on the scope of services provision in the provider contract.

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Sarah

6 months ago

Based on my understanding, if the service is included in the scope of services, then Dr. Kwan most likely did not need to get authorization. But he was probably paid on a fee-for-service basis for that particular service.

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Samira

6 months ago

I think XML-Encryption and SAML are both related to security, but I'm not sure if they specifically enable non-repudiation. I'll have to double-check the definitions of these standards.

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Maryann

11 months ago

This question is about as clear as mud. I'm just going to go with option E and hope for the best. Maybe I'll get lucky and the exam grader will have a good sense of humor, and they'll give me partial credit for the 'Dr. Kwan the Juggling Maverick' joke I just came up with.

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Pearly

10 months ago

Yeah, I'm going with option E too.

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Angella

10 months ago

I agree, Dr. Kwan was most likely paid on a FFS basis.

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Honey

10 months ago

I think option E is the best choice here.

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Erick

11 months ago

Option B, all the way. Dr. Kwan is a true entrepreneur, and he's probably billing Poplar on a FFS basis for this service. I bet he's got a secret side hustle going on, too - maybe he's moonlighting as a professional juggler or something.

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Lore

11 months ago

I'm going to have to go with option D - A only. I mean, it just makes sense that Dr. Kwan would need to get the greenlight from Poplar before providing this service. He's not about to rock the boat and risk losing that sweet, sweet Poplar cash.

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Cordelia

9 months ago

Definitely, can't risk losing that Poplar contract.

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Helga

9 months ago

Yeah, it's better to play it safe and follow the rules.

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Coral

10 months ago

I agree, Dr. Kwan probably had to get approval from Poplar before doing anything.

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Ezekiel

11 months ago

Option F, definitely. Dr. Kwan is a maverick, and he's not going to let some pesky contract stop him from doing what he thinks is best for his patients. I bet he just laughed in the face of Poplar's authorization requirements.

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Belen

11 months ago

Hmm, this looks like a tricky one. I'm going to go with option C - both A and B seem plausible based on the typical scope of services provision. After all, who wants to get on the bad side of the Poplar Health Plan?

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