AHIP Health Plan Finance and Risk Management AHM-520 Question # 110 Topic 5 Discussion

AHIP Health Plan Finance and Risk Management AHM-520 Question # 110 Topic 5 Discussion

AHM-520 Exam Topic 5 Question 110 Discussion:
Question #: 110
Topic #: 5

Juan Ramirez, a licensed social worker, and Dr. Laura Lui, a licensed psychiatrist, are under contract to the Peninsula Health Plan. Peninsula has contracted with CMS to provide services to Medicare and Medicaid beneficiaries. Both Mr. Ramirez and Dr. Lui provide the same type of counseling services to Peninsula's enrollees. With respect to amendments made to the Balanced Budget Act (BBA) of 1997 that impact provider reimbursement, the amount by which Peninsula will reimburse Mr. Ramirez will be equal to:


A.

50% of Dr. Lui's reimbursement


B.

75% of Dr. Lui's reimbursement


C.

90% of Dr. Lui's reimbursement


D.

100% of Dr. Lui's reimbursement


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