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Exam AHM-530 topic 1 question 107 discussion

Actual exam question from AHIP's AHM-530
Question #: 107
Topic #: 1
[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:

  • A. limit the size of its network to the number of providers necessary to meet the needs of its enrollees
  • B. require providers to accept as payment in full an amount no greater than 115% of the Medicare payment rate
  • C. refuse payment to non-network providers who submit claims for Medicare-covered expenses
  • D. shift all risk for Medicare-covered services to network providers
Show Suggested Answer Hide Answer
Suggested Answer: B 🗳️

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