AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 1:

  This agency oversees the Federal Employee Health Benefits Program (FEHBP).

  A. Health Resources and Services Administration (HRSA)
  B. Office of Personnel Management (OPM)
  C. Department of Health and Human Services (HHS)
  D. Department of Justice (DOJ)
  B. Office of Personnel Management (OPM)

• Question 2:

  Health plans that choose to contract with external organizations for pharmacy services typically contract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for a health plan include 1.Managing the costs of prescription drugs 2.Promoting efficient and safe drug use 3.Determining the health plan's internal management responsibilities for pharmacy services

  A. All of the above
  B. 1 and 2 only
  C. 2 and 3 only
  D. 1 only
  B. 1 and 2 only

• Question 3:

  The Riverside Health Plan is considering the following provider compensation options to use in its contracts with several provider groups and hospitals:

  1.

  A discounted fee-for-service (DFFS) payment system

  2.

  A case rate system

  3.

  Capitation If Riverside wants to use only those compensation methods that encourage the efficient use of resources, then the compensation method(s) that Riverside should consider for its new contracts include

  A. 1, 2, and 3
  B. 1 and 2 only
  C. 2 and 3 only
  D. 3 only
  C. 2 and 3 only

• Question 4:

  The delivery of quality, cost-effective healthcare is a primary goal of both group healthcare and workers' compensation programs. One difference between group healthcare and workers' compensation is that workers' compensation

  A. provides health and disability benefits to employees injured on the job only if the employer is at fault for the injury
  B. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs
  C. manages costs by including employee cost-sharing features in its benefit design
  D. places limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits
  B. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs

• Question 5:

  Benchmarking is a quality improvement strategy used by some health plans. With regard to benchmarking, it is correct to say that

  A. cost-based benchmarking reveals why some areas of a health plan perform better or worse than comparable areas of other organizations
  B. diagnosis-related groups (DRGs) are a source of benchmarking data that describe individual procedures and cover both inpatient and outpatient care
  C. patient billing records provide a much more accurate account of procedure costs for benchmarking than do current procedural terminology (CPT) codes
  D. the focus of benchmarking for health plan has shifted from identifying the lowest cost practices to identifying best practices
  D. the focus of benchmarking for health plan has shifted from identifying the lowest cost practices to identifying best practices

• Question 6:

  Economically, health plans cannot provide coverage for every drug available from every manufacturer. As a result, purchaser contracts often include provisions specifying that certain drugs or drug types will not be covered. These provisions are referred to as

  A. limitations
  B. exceptions
  C. exclusions
  D. drug edits
  C. exclusions

• Question 7:

  The following statements are about chronic and disabling conditions among children eligible for Medicaid. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. Children with chronic conditions use more physician and nonphysician professional services than do children in the general population.
  B. The majority of chronic conditions affecting children in Medicaid programs are the same as those affecting children in the general population.
  C. Medicaid-eligible children are at risk for seriousmental and physical conditions.
  D. Children in Medicaid programs have a higher incidence of chronic disabling conditions than do children in the general population.
  B. The majority of chronic conditions affecting children in Medicaid programs are the same as those affecting children in the general population.

• Question 8:

  When analyzing and applying HRA results, the Multistate Health Plan noted sampling bias. This information indicates that the HRA results

  A. do not accurately depict the characteristics of the Multistate member population under study because of errors in data collection
  B. are more accurate for individual Multistate members than they are for the total population
  C. cannot be stated in numerical terms
  D. indicate variation in the number, types, and severity of behavioral risks presented by Multistate's members
  A. do not accurately depict the characteristics of the Multistate member population under study because of errors in data collection

• Question 9:

  Some health plans administer a questionnaire known as the Behavioral Risk Factor Surveillance System (BRFSS) as part of their health risk assessment (HRA) processes. The following statements are about the BRFSS. If statements (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct statement.

  A. This questionnaire was designed specifically for use by health plans.
  B. Each health plan must use the same form of the questionnaire, with no additions or modifications.
  C. This questionnaire monitors the prevalence of the major behavioral risks associated with illness and injury among adults.
  D. All of the above statements are correct.
  C. This questionnaire monitors the prevalence of the major behavioral risks associated with illness and injury among adults.

• Question 10:

  The Harbor Health Plan's formulary policy encourages network pharmacists who are asked to fill a prescription for a costly, brand-name drug to dispense a different chemical entity within the same drug class in order to reduce costs. This type of drug substitution is referred to as

  A. generic substitution, and prescriber approval is not required
  B. generic substitution, and prescriber approval is always required
  C. therapeutic substitution, and prescriber approval is not required
  D. therapeutic substitution, and prescriber approval is always required
  D. therapeutic substitution, and prescriber approval is always required