AHIP AHIP Certifications AHM-540 Questions & Answers

• Question 121:

  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.

  Correct Answer: C

• Question 122:

  As a follow-up to a performance improvement plan for member services, the Stellar Health Plan conducted an evaluation of the success of the plan. Stellar conducted its evaluation as the plan was being carried out. The evaluation focused on specific activities and assessed the relative importance of those activities to the plan as a whole. This information indicates that Stellar's evaluation of the plan was both

  A. concurrent and formative

  B. concurrent and summative

  C. retrospective and formative

  D. retrospective and summative

  Correct Answer: A

• Question 123:

  PBMs are accredited by the same organizations that accredit health plans.

  A. True

  B. False

  Correct Answer: B

• Question 124:

  Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the

  A. lack of qualified providers in provider networks

  B. lack of resources necessary to establish case management programs for patients with complex conditions

  C. unstable eligibility status of Medicaid recipients

  D. inability of Medicaid recipients to change health plans or PCPs

  Correct Answer: C

• Question 125:

  The following statements are about QAPI as it applies to Medicare+Choice plans and Medicaid health plan entities. Select the answer choice containing the correct statement.

  A. QAPI provides separate sets of standards for Medicaid MCEs and Medicare+Choice plans.

  B. Medicaid primary care case management (PCCM) programs are required to comply with all QAPI standards.

  C. QISMC standards for quality measurement and improvement apply only to clinical services delivered to Medicare and Medicaid enrollees.

  D. States that require Medicaid MCEs to comply with QAPI standards are considered to be in compliance with CMS quality assessment and improvement regulations.

  Correct Answer: D

• Question 126:

  Health plans often use accreditation as a means of evaluating the quality of care delivered to plan members. Accreditation of subacute care providers is available from the

  A. National Committee for Quality Assurance (NCQA)

  B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

  C. American Accreditation HealthCare Commission/URAC (URAC)

  D. Foundation for Accountability (FACCT)

  Correct Answer: B

• Question 127:

  Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

  The document that Mr. Farrell is using to communicate his end-of-life healthcare wishes to his family is known as a

  A. medical power of attorney

  B. patient assessment and care plan

  C. living will

  D. healthcare proxy

  Correct Answer: C

• Question 128:

  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.

  Correct Answer: C

• Question 129:

  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

  Correct Answer: D

• Question 130:

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

  Calvin Montrose, age 75, has difficulty performing basic self-care activities, such as bathing, dressing, and eating, without assistance. This information indicates that Mr. Montrose needs assistance with (activities of daily living / instrumental activities of daily living) that are used to measure his (functional status / health status).

  A. activities of daily living / functional status

  B. activities of daily living / health status

  C. instrumental activities of daily living / functional status

  D. instrumental activities of daily living / health status

  Correct Answer: A