AHIP Exam AHM-530 Topic 6 Question 101 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 101
Topic #: 6

The Foxfire Health Plan, which has 20,000 members, contracts with dermatologists on a contact capitation basis. The contact capitation arrangement has the following features:

Foxfire distributes the money in the contact capitation fund once each quarter and the distribution is based on the point totals accumulated by each dermatologist.

Foxfire's per member per month (PMPM) capitation for dermatology services is $1.

The dermatologist receives 1 point for each new referral that is not classified as a complicated referral and 1.5 points for each new referral that is classified as complicated.

During the first quarter, Foxfire's PCPs made 450 referrals to dermatologists and 100 of these referrals were classified as complicated. One dermatologist, Dr. Shareef Rashad, received 42 of these referrals; 6 of his referrals were classified as complicated. Statements that can correctly be made about Foxfire's contact capitation arrangement include:

Athat the value of each referral point for the first quarter was $120

Bthat the value of Foxfire's contact capitation fund for dermatologists for the first quarter was $20,000

Cthat the payment that Foxfire owed Dr. Rashad for the first quarter was $6,120

Dall of the above

Show Suggested Answer

Suggested Answer: A

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

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Quentin

5 months ago

Foxfire must have really 'dermatized' their payment system. I'm going with option C, no skin off my back!

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Deeann

5 months ago

I bet Dr. Rashad is feeling pretty 'rash-ed' about this whole capitation thing. Option C it is!

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5 months ago

Wow, 100 complicated referrals out of 450? Foxfire's PCPs must have been really stumped. Option C seems like the way to go here.

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Novella

4 months ago

Option C does seem like the correct choice.

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Patria

4 months ago

Yeah, 100 complicated referrals is a lot.

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Orville

5 months ago

Dr. Rashad must have been busy with those referrals.

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6 months ago

Hmm, this capitation arrangement seems complex, but I think option C is the correct answer. Dr. Rashad must have really impressed with all those referrals!

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