AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 101:

  One way that health plans evaluate their UR programs is by monitoring utilization rates. By definition, utilization rates typically

  A. indicate changes in the total amount of medical expenses or claim dollars paid for particular procedures
  B. measure the number of services provided per 1,000 members per year
  C. indicate standard approaches to care for many common, uncomplicated healthcare services
  D. report the number of times that a particular provider performs or recommends a service excluded from the benefit plan
  B. measure the number of services provided per 1,000 members per year

• Question 102:

  Maxwell Midler's health plan operates a drug formulary that includes a typical three-tier copayment structure with required copayments of $5, $10, and $25. Mr. Midler recently filled a prescription for a $75 drug that was not included in the formulary. According to the plan's formulary copayment structure, the amount that Mr. Midler was required to pay for his prescription was

  A. $5
  B. $10
  C. $25
  D. $75
  C. $25

• Question 103:

  The following statements describe situations in which health plan members have medical problems that require care. Select the statement that describes a situation in which self- care most likely would not be appropriate.

  A. Two days after bruising her leg, Avis Bennet notices that the pain from the bruise has increased and that there are red streaks and swelling around the bruised area.
  B. Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several times each day.
  C. Caroline Evans has severe arthritis that requires regular exercise and oral medication to reduce pain and help her maintain mobility.
  D. Oscar Gracken is recovering from a heart attack and requires ongoing cardiac rehabilitation.
  A. Two days after bruising her leg, Avis Bennet notices that the pain from the bruise has increased and that there are red streaks and swelling around the bruised area.

• Question 104:

  The following statement(s) can correctly be made about the hospitalist approach to inpatient care management: 1.Management of inpatient care by hospitalists may significantly reduce the length of stay and the total costs of care for a hospital admission 2.Most health plans that use hospitalists do so through a voluntary hospitalist program

  3.A

  hospitalist's familiarity with utilization management (UM) and quality management (QM) standards for inpatient care may reduce unnecessary variations in care and improve clinical outcomes

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

• Question 105:

  The American Accreditation HealthCare Commission/URAC (URAC) has an accreditation program specifically for case management services. From the answer choices below, select the response that correctly identifies the type(s) of case management services addressed by URAC's standards and the type(s) of organizations to which these standards may be applied.

  A. Type(s) of Services-on-site services only Type(s) of Organization-health plans only
  B. Type(s) of Services-on-site services only Type(s) of Organization-any organization that performs case management functions
  C. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-health plans only
  D. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-any organization that performs case management functions
  D. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-any organization that performs case management functions

• Question 106:

  Health plans conduct evaluations on the efficiency and effectiveness of their quality improvement activities. With regard to the effectiveness of quality improvement plans, it is correct to say that

  A. effectiveness is the relationship between what the organization puts into an improvement plan and what it gets out of the plan
  B. effectiveness is measured by reviewing outcomes to determine the accuracy or appropriateness of the strategy and the adequacy of resources allocated to that strategy
  C. the effectiveness of an action plan is typically measured with a concurrent evaluation
  D. an evaluation of plan effectiveness produces one of two results: the plan either (a) achieved the desired outcomes or (b) did not achieve the desired outcomes and is unlikely to do so under current conditions
  B. effectiveness is measured by reviewing outcomes to determine the accuracy or appropriateness of the strategy and the adequacy of resources allocated to that strategy

• Question 107:

  The case management program director at the Nova Health Plan calculated the program's ratio of medical expense savings to case management administrative costs for the previous quarter based on the following cost information: Administrative costs for case management ..........$40,000 Actual medical care expenses for patients under case management ..........$680,000 Projected medical care expenses for the same patients without case management ..........$900,000 This information indicates that, for the previous quarter, Nova's ratio of medical expense savings to case management administrative costs was

  A. 0.71/1
  B. 0.80/1
  C. 5.50/1
  D. 1.25/1
  C. 5.50/1

• Question 108:

  7. One method that health plans use to address provider compliance with formularies is academic detailing.

  A. True
  B. False
  A. True

• Question 109:

  Emilio Martinez, a member of the Bloom Health Plan, has recently been diagnosed with prostate cancer by his physician, Dr. Robert Cohen. Mr. Martinez has decided to participate in Bloom's shared decision-making program for prostate cancer. On the basis of this information, it is most likely correct to say

  1.That verification of Mr. Martinez's understanding about his care options protects both Dr. Cohen and Bloom against charges of malpractice

  2.That Mr. Martinez and Dr. Cohen will discuss the care options available to Mr. Martinez, but the ultimate decision about care is up to Dr. Cohen

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

• Question 110:

  Drugs included in a health plan's formulary can be classified according to how freely they can be prescribed. By definition, a drug that requires some sort of review or approval by a plan physician or group of physicians before the prescription can be filled is

  A. an unrestricted drug
  B. a monitored drug
  C. a restricted drug
  D. a conditional drug
  B. a monitored drug