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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Talia

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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