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AHIP AHM-530 Exam - Topic 6 Question 101 Discussion

Actual exam question for AHIP's AHM-530 exam
Question #: 101
Topic #: 6
[All AHM-530 Questions]

The BBA of 1997 specifies the ways in which a Medicare+Choice plan can establish and use provider networks. A Medicare+Choice plan that operates as a private fee for service (PFFS) plan is allowed to

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Suggested Answer: A

by Bernadine at Sep 19, 2024, 07:59 AM

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Twana
4 months ago
Totally agree, they can set payment limits too!
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Silva
4 months ago
Wait, can they really shift all risk to network providers?
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Cecilia
4 months ago
They can refuse payment to non-network providers, that's true.
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Carissa
4 months ago
I thought they had to accept all providers?
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Cordell
5 months ago
PFFS plans can limit their network size.
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Blondell
5 months ago
I don't think they can shift all risk to network providers; that seems too extreme for a PFFS plan.
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Lisha
5 months ago
I feel like I read that PFFS plans can refuse payment to non-network providers, but I can't recall the specifics.
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Pamella
5 months ago
I think option B sounds familiar from our practice questions, where providers had to accept a certain payment rate.
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Felix
5 months ago
I remember something about PFFS plans having flexibility with provider networks, but I'm not sure if they can limit the network size.
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Jaleesa
5 months ago
This is a tricky one. I'm not sure if I fully understand the differences between the various Medicare plan types and their network requirements. I'll have to review my notes and try to reason through the options methodically.
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Huey
5 months ago
Hmm, I'm a little unsure about this one. The wording is a bit technical, and I'm not super familiar with the details of the BBA and Medicare+Choice plans. I'll have to think through each answer choice carefully to try to figure out the right one.
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Zana
5 months ago
This question seems straightforward - it's asking about the specific provisions of the BBA of 1997 regarding Medicare+Choice plans. I'll need to carefully read through the answer choices to determine which one accurately describes the allowed practices for PFFS plans.
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Benedict
6 months ago
Okay, I think I've got this. The key is understanding that a PFFS plan is allowed to limit its network size and control provider payments, but can't refuse to pay non-network providers. I'm pretty confident option B is the correct answer.
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Mitsue
10 months ago
Option B is the way to go, folks. Limiting provider payments to 115% of the Medicare rate - that's the key thing PFFS plans can do according to the BBA. Now excuse me while I go practice my 'haggling with providers' skills.
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Juan
9 months ago
Definitely, being able to limit payments to 115% of the Medicare rate can help control costs.
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Viola
9 months ago
I think it's important for plans to have that flexibility in setting payment limits.
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Louvenia
10 months ago
It's all about negotiating those payment rates with providers.
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Odelia
10 months ago
I agree, option B is definitely a game changer for PFFS plans.
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Ira
10 months ago
Alright, let's see here. I'm going to have to go with option B. It just makes the most sense when it comes to PFFS plan requirements under the BBA of '97. Solid choice, if I do say so myself.
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Cletus
10 months ago
Haha, imagine if PFFS plans could just shift all the risk to the providers. That would be like playing 'hot potato' with Medicare-covered services! But I digress, I'd go with option B.
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Annette
9 months ago
User 3: I think option B makes the most sense, providers shouldn't be burdened with all the risk.
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Weldon
9 months ago
User 2: I agree, it would definitely make things interesting.
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Bettina
10 months ago
User 1: Haha, that would be quite the game of 'hot potato' with Medicare-covered services!
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Ronald
11 months ago
Hmm, this is a tricky one. I'm leaning towards option C, as PFFS plans can refuse payment to non-network providers. Gotta watch out for those sneaky non-network docs!
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Donette
10 months ago
Definitely, being aware of the rules around provider networks is crucial when choosing a Medicare+Choice plan.
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Colby
10 months ago
I agree, it's important to understand how PFFS plans handle payments to non-network providers.
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Lacey
10 months ago
I think you're onto something with option C. Non-network providers can be tricky.
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Ayesha
11 months ago
I'm not sure, but I think the answer might be C.
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Dan
11 months ago
I disagree, I believe the answer is A.
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Gennie
11 months ago
I think the answer is B.
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Simona
11 months ago
I see your point, but I still think A is the correct answer because it makes sense for the plan to limit the size of its network to meet the needs of its enrollees.
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Tamar
11 months ago
I think option B is the correct answer. The BBA of 1997 allows PFFS plans to limit the payment to providers to 115% of the Medicare rate.
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Merissa
10 months ago
Yes, it could be a challenge to find providers willing to accept the payment terms.
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Cordelia
10 months ago
But doesn't that also mean providers may be less willing to participate?
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Viva
10 months ago
That makes sense. It helps control costs for the plan.
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Glory
10 months ago
I agree, option B is correct. PFFS plans can limit payment to 115% of Medicare rate.
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Eura
12 months ago
I disagree, I believe the answer is B.
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Simona
12 months ago
I think the answer is A.
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