AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 91:

  The following statement(s) can correctly be made about the scope of case management: 1.Case management incorporates activities that may fall outside a health plan's typical responsibilities, such as assessing a member's financial situation 2.Case management generally requires a less comprehensive and complex approach to a course of care than does utilization review 3.Case management is currently applicable only to medical conditions that require inpatient hospital care and are categorized as catastrophic in terms of health and/or costs

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

• Question 92:

  Determine whether the following statement is true or false:

  The utilization review (UR) process produces the greatest number of case management referrals.

  A. True
  B. False
  A. True

• Question 93:

  Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQA. These NCQA credentialing standards apply to

  A. chiropractors
  B. naturopaths
  C. acupuncturists
  D. all of the above
  A. chiropractors

• Question 94:

  Most health plans require a PCP referral or precertification for CAM benefits.

  A. True
  B. False
  B. False

• Question 95:

  Administrative action plans are used when performance problems or opportunities are related to the way the organization itself operates. The following statement(s) can correctly be made about administrative action plans: 1.Administrative action plans allow health plans to coordinate management activities 2.One function of administrative action plans is to integrate service across all levels of the organization 3.Administrative action plans are designed to improve outcomes by helping plan members assume responsibility for their own health

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

• Question 96:

  Private employers are key purchasers of health plan services. The following statement(s) can correctly be made about employer expectations about the quality and cost- effectiveness of healthcare services:

  1.

  For both health maintenance organizations (HMOs) and non-HMO plans, employers typically have access to accreditation results and performance measurement reports to help them evaluate the quality of healthcare and service

  2.

  Because of employers' concern about the quality and costs of healthcare services available through health plans, direct contracting has become a dominant model among employers who sponsor health benefit programs for their employees

  A. Both 1 and 2
  B. 1 only
  C. 2 only D. Neither 1 nor 2
  D

• Question 97:

  The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to A. remove behavioral healthcare services from the primary care setting

  B. shift behavioral healthcare from acute inpatient settings to alternative settings when feasible
  C. reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient
  D. offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members
  B. shift behavioral healthcare from acute inpatient settings to alternative settings when feasible

• Question 98:

  For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

  The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans' efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

  A. standard medical-surgical services
  B. mental health and substance abuse services
  C. services offered to Medicare enrollees as optional supplementary benefits
  D. all of the above
  D. all of the above

• Question 99:

  Performance variance can be classified as either common cause variance or special cause variance. The following statement(s) can correctly be made about special cause variance: 1.Inadequate staffing levels, employee errors, and equipment malfunctions are examples of special cause variance 2.Special cause variance is typically more difficult to detect and correct than is common cause variance

  A. Both 1 and 2
  B. 1 only
  C. 2 only
  D. Neither 1 nor 2
  B. 1 only

• Question 100:

  Designing effective medical management programs for Medicare beneficiaries requires an understanding of the unique health needs of the Medicare population. One characteristic of Medicare beneficiaries is that they typically

  A. do not experience mental health problems
  B. consume more than half of all prescription drugs
  C. are likely to equate quality with the technical aspects of clinical procedures
  D. require longer and more costly recovery periods following acute illnesses or injuries than does the general population
  D. require longer and more costly recovery periods following acute illnesses or injuries than does the general population