AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 131:

  In order to achieve changes in outcomes, health plans make changes to existing structures and processes. The introduction of preauthorization as an attempt to control overuse of services is an example of a reactive change. Reactive changes are typically

  A. both planned and controlled
  B. planned, but they are rarely controlled
  C. controlled, but they are rarely planned
  D. neither planned nor controlled
  C. controlled, but they are rarely planned

• Question 132:

  The Mental Health Parity Act (MHPA) of 1996 is a federal law that establishes requirements for behavioral healthcare coverage for group plan members. The MHPA

  A. requires health plans to offer mental health benefits to all eligible members
  B. prohibits health plans that offer mental health benefits from imposing lower annual or lifetime dollar limits on mental illnesses than they do on physical illnesses
  C. provides an exemption for health plans that can demonstrate cost savings of more than 1 percent
  D. prohibits health plans from limiting the number of outpatient visits or inpatient days covered under the plan
  B. prohibits health plans that offer mental health benefits from imposing lower annual or lifetime dollar limits on mental illnesses than they do on physical illnesses

• Question 133:

  To see that utilization guidelines are consistently applied, UR programs rely on authorization systems. Determine whether the following statement about authorization systems is true or false: Only physicians can make nonauthorization decisions based on medical necessity.

  A. True
  B. False
  A. True

• Question 134:

  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.

  The following statement(s) can correctly be made about Harbrace's use of extra- contractual coverage: 1.Harbrace's medical policy most likely establishes the procedure that Harbrace used to evaluate the value of Upzil for treating Ms. Ray 2.One way for Harbrace to reduce the risk associated with extra-contractual coverage is by including an alternative care provision in its contracts with purchasers

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

• Question 135:

  One of the steps in drug utilization review (DUR) is defining optimal drug use, which can be accomplished by applying diagnosis criteria and drug-specific criteria. Drug-specific criteria are standards that identify the

  A. appropriate dosages, duration of treatment, and other elements related to the use of a particular drug
  B. actual prescribing and dispensing patterns for a particular drug
  C. types of diseases, conditions, or patients for which a drug should be used
  D. cost-effectiveness of all possible drug treatments for a particular condition
  A. appropriate dosages, duration of treatment, and other elements related to the use of a particular drug

• Question 136:

  In recent years, the demand for prescription drugs has increased dramatically. Factors that have contributed to this increase include

  A. increased education regarding the purpose and benefits of drug formularies
  B. reductions in the cost of prescription drugs
  C. increased use of direct-to-consumer (DTC) advertising
  D. all of the above
  C. increased use of direct-to-consumer (DTC) advertising

• Question 137:

  A health plan's coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1.In case of conflict between the purchaser contract and a health plan's medical policy or benefits administration policy, the contract takes precedence 2.Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3.All of the criteria for coverage decisions must be included in the purchaser contract

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

• Question 138:

  Health plans have a specified number of working days to respond to Level One appeals, as stated by company policy or regulatory requirements. With regard to the timeframes for appeals, it is generally correct to say 1.That the typical timeframe requires a health plan to respond to appeals in fewer than 20 days 2.That the timeframe is accelerated for expedited appeals 3.That the review period begins when the appeal arrives at a health plan

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

• Question 139:

  Determine whether the following statement is true or false:

  The key to successfully managing the quality and cost-effectiveness of healthcare services for Medicaid enrollees is to merge Medicaid recipients into existing plans.

  A. True
  B. False
  B. False

• Question 140:

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

  A primary distinction between skilled care and subacute care relates to the extent and medical complexity of the patient's needs. Generally, subacute care patients require (more / fewer) services from physicians and nurses and (more / less) extensive rehabilitation services than do skilled care patients.

  A. more / more
  B. more / less
  C. fewer / more
  D. fewer / less
  A. more / more