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AHIP Exam AHM-530 Topic 5 Question 103 Discussion

Actual exam question for AHIP's AHM-530 exam
Question #: 103
Topic #: 5
[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 Gail at Nov 17, 2024, 06:55 PM

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Burma
4 months ago
I'm not sure, but I think it could also be considered upcoding.
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Ammie
4 months ago
I agree with Pearly, Dr. Koenig's actions seem like unbundling.
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Arlene
4 months ago
D) Unbundling all the way. Trying to game the system like that is just bad news. Didn't they teach medical ethics in this doc's training or what?
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Kaitlyn
3 months ago
It's a clear case of trying to get more money than deserved.
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Emelda
3 months ago
I agree, it's not right to unbundle charges like that.
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Anabel
3 months ago
That's definitely unethical. Dr. Koenig should know better.
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Winfred
4 months ago
Haha, I bet Dr. Koenig thought she was being real slick with this one. But D) Unbundling is the way to go, no doubt about it.
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Pearly
4 months ago
I think the answer is D) Unbundling.
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Elden
4 months ago
Definitely D) Unbundling. Trying to get paid multiple times for the same procedure is just plain wrong.
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Julian
3 months ago
It's important for healthcare providers to follow coding guidelines.
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Tora
3 months ago
Unbundling is a serious issue in healthcare billing.
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Martha
3 months ago
I agree, it's unfair to the health plan and the patient.
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Felix
4 months ago
That's definitely unethical. Dr. Koenig should know better.
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Jerry
4 months ago
I think the correct answer is D) Unbundling. Dr. Koenig is trying to get separate reimbursement for services that should have been included in the single code for the surgical procedure.
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Rodney
3 months ago
Dr. Koenig should have included all charges in the surgical procedure code.
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Jade
3 months ago
I think unbundling is the most appropriate term for this situation.
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Viola
3 months ago
It's definitely not upcoding or churning.
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Whitley
3 months ago
I agree, Dr. Koenig's actions are an example of unbundling.
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