AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 111:

  The following statement(s) can correctly be made about the use of screening for secondary prevention: 1.Screening activities may involve specialty care providers as well as primary care providers (PCPs) and the health plan 2.Secondary prevention often results in more utilization of services immediately following screening 3.Screening focuses on members who have not experienced any symptoms of a particular illness

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

• Question 112:

  One method of transferring the information in electronic medical records (EMRs) is through a health information network (HIN). The following statements are about HINs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. A HIN may afford a health plan better measurements of outcomes and provider performance.
  B. The use of a HIN typically increases a health plan's exposure to liability for poor care.
  C. Most HINs are Internet-based rather than built on proprietary computer networks.
  D. Currently, the majority of health plans do not have HINs that are capable of transferring medical records among their network providers.
  B. The use of a HIN typically increases a health plan's exposure to liability for poor care.

• Question 113:

  The paragraph below contains two pairs of terms or phrases enclosed in parentheses. Select the term or phrase in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms or phrases you have chosen.

  TRICARE enrollees have the right to challenge authorization and coverage decisions. Such challenges are referred to as (appeals / grievances) and are typically handled by the (TRICARE contractor / Area Field Office).

  A. appeals / TRICARE contractor
  B. appeals / Area Field Office
  C. grievances / TRICARE contractor
  D. grievances / Area Field Office
  A. appeals / TRICARE contractor

• Question 114:

  Determine whether the following statement is true or false:

  All health plans participating in the Federal Employee Health Benefits Program (FEHBP) are required to use the Consumer Assessment of Health Plans (CAHPS) to measure customer satisfaction.

  A. True
  B. False
  A. True

• Question 115:

  Accreditation is intended to help purchasers and consumers make decisions about healthcare coverage. The following statements are about accreditation. Select the answer choice containing the correct statement.

  A. At the request of health plans, accrediting agencies gather the data needed for accreditation.
  B. Most purchasers and consumers review accreditation results when making decisions to purchase or enroll in a specific health plan.
  C. Accreditation is typically conducted by independent, not-for-profit organizations.
  D. All health plans are required to participate in the accreditation process.
  C. Accreditation is typically conducted by independent, not-for-profit organizations.

• Question 116:

  Serena Wilson, a registered nurse, is employed at a TRICARE Service Center (TSC) located at a military installation. Ms. Wilson serves as a primary point of contact between enrollees and the TRICARE system and answers enrollees' questions about plan options, eligibility, provider selection, and claims. This information indicates that Ms. Wilson serves as a

  A. lead agent
  B. beneficiary services representative
  C. health plan support contractor
  D. primary care manager (PCM)
  B. beneficiary services representative

• Question 117:

  In order to be effective, a clinical pathway must improve quality and decrease costs.

  A. True
  B. False
  B. False

• Question 118:

  The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.

  Definitions of quality healthcare vary; however, four dimensions are essential to quality healthcare services. ________________ is the quality dimension indicating that services result in the best care for a given cost or the lowest cost for a given level of care.

  A. Accessibility
  B. Effectiveness
  C. Acceptability
  D. Efficiency
  D. Efficiency

• Question 119:

  Since its inception, Medicare has undergone a number of changes because of legal and regulatory action. One result of the Balanced Budget Act (BBA) of 1997 has been to

  A. expand Medicare benefits by mandating coverage for certain preventive services
  B. reduce the number of organizations that can deliver covered services
  C. encourage growth of managed Medicare programs in all markets
  D. increase the number of "zero premium" plans available to Medicare beneficiaries
  A. expand Medicare benefits by mandating coverage for certain preventive services

• Question 120:

  In order to provide a true measure of quality, the data collected by a quality indicator should accurately represent the service dimension being measured. This information indicates that the indicator should exhibit the characteristic known as

  A. clarity
  B. reliability
  C. validity
  D. feasibility
  C. validity