AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 121:

  Outcomes management is a tool that health plans use to maximize all the results associated with healthcare processes. The following statement(s) can correctly be made about outcomes management: 1.The goal of outcomes management is to identify and implement treatments that are cost- effective and deliver the greatest value 2.Outcomes management introduces performance as a critical factor in the assessment and improvement of outcomes

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

• Question 122:

  The Hall Health Plan gathered objective clinical information about the recommended uses and dosages of angiotensin-converting enzyme (ACE) inhibitors and presented the information to network providers to illustrate the appropriate use of these frequently prescribed and expensive drugs. This information indicates that Hall most likely educated its network providers through the use of

  A. detailing
  B. cognitive services
  C. counter detailing
  D. drug efficacy study implementation (DESI)
  C. counter detailing

• Question 123:

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

  One component of UR is an administrative review. An administrative review compares the proposed medical care to the applicable (medical policy / contract provision). This type of review (can / cannot) be conducted by a nonclinical staff member.

  A. medical policy / can
  B. medical policy / cannot
  C. contract provision / can
  D. contract provision / cannot
  C. contract provision / can

• Question 124:

  Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treat Ms. Ray's condition, her physician has prescribed Upzil, a medication that has Food and Drug Administration (FDA) approval only for the treatment of depression. Upzil has not been tested for safety or effectiveness in the treatment of migraine headache. Although Harbrace's medical policy for migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extra-contractual coverage of Upzil for Ms. Ray.

  In this situation, the prescribing of Upzil for Ms. Ray's headaches is an example of

  A. a cosmetic service
  B. an investigational service
  C. an off-label use
  D. a quality-of-life service
  C. an off-label use

• Question 125:

  All states have laws describing the conditions under which pharmacists can substitute a generic drug for a brand-name drug. With respect to these laws, it is correct to say that in every state,

  A. pharmacists must obtain physician approval before substituting generics for brand-name drugs
  B. pharmacists must obtain authorization from the health plan before substituting generics for brand-name drugs
  C. prescribers must obtain authorization from the health plan before prescribing a brand- name drug
  D. prescribers have some mechanism that allows them to prevent pharmacists from substituting generics for brand-name drugs
  D. prescribers have some mechanism that allows them to prevent pharmacists from substituting generics for brand-name drugs

• Question 126:

  Determine whether the following statement is true or false:

  Under a carve-out arrangement for disease management, patients typically maintain their existing relationships with primary care providers (PCPs) for all care, including disease management.

  A. True
  B. False
  B. False

• Question 127:

  Various government and independent agencies have created tools to measure and report the quality of healthcare. One performance measurement tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) is

  A. the Health Plan Employer Data and Information Set (HEDIS?, which is a report card system for hospitals and long-term care facilities
  B. HEDIS, which is a performance measurement tool that addresses both effectiveness of care and plan member satisfaction
  C. the Consumer Assessment of Health Plans (CAHPS?, which was established to develop and implement a national strategy for quality measurement and reporting
  D. CAHPS, which is a tool that measures consumer satisfaction with specific aspects of health plan services
  D. CAHPS, which is a tool that measures consumer satisfaction with specific aspects of health plan services

• Question 128:

  The following statements are about disease management programs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. The focus of disease management is on responding to the needs of individual members for extensive, customized healthcare supervision.
  B. Disease management programs serve to improve both clinical and financial outcomes for healthcare services related to chronic conditions.
  C. Tools such as preventive care, self-care, and decision support programs are used to support both case management and disease management.
  D. Disease management programs apply to both diseases and medical conditions that are not diseases, such as high-risk pregnancy, severe burns, and trauma.
  A. The focus of disease management is on responding to the needs of individual members for extensive, customized healthcare supervision.

• Question 129:

  Step-therapy is a form of prior authorization that reserves the use of more expensive medications for cases in which the use of less expensive medications has been unsuccessful. Step-therapy is appropriate for situations in which

  1.A

  significant percentage of those treated with the initial therapy will require the second therapy 2.The delay created when a patient moves from one therapy to the next therapy will not cause serious or permanent effects

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

• Question 130:

  Home healthcare encompasses a wide variety of medical, social, and support services delivered at the homes of patients who are disabled, chronically ill, or terminally ill. The time period(s) when health plans typically use home healthcare include 1.The period prior to a hospital admission 2.The period following discharge from a hospital

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