AHIP Exam AHM-530 Topic 5 Question 103 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 103
Topic #: 5

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:

AUpcoding

BA wrap-around

CChurning

DUnbundling

Show Suggested Answer

Suggested Answer: D

by Gail at Nov 17, 2024, 06:55 PM

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Burma

7 days ago

I'm not sure, but I think it could also be considered upcoding.

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Ammie

10 days ago

I agree with Pearly, Dr. Koenig's actions seem like unbundling.

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Arlene

14 days 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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Winfred

17 days 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

20 days ago

I think the answer is D) Unbundling.

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Elden

23 days ago

Definitely D) Unbundling. Trying to get paid multiple times for the same procedure is just plain wrong.

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Felix

3 days ago

That's definitely unethical. Dr. Koenig should know better.

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Jerry

26 days 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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