AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 151:

  Selene Varga is participating in her health plan's disease management program for congestive heart failure. Ms. Varga's health status is regularly monitored and managed by a licensed nurse who visits Ms. Varga at her home to administer treatment and assess the need for changes in Ms. Varga's overall care plan. This information indicates that Ms. Varga is participating in the type of disease management program known as a

  A. coordinated outreach model program
  B. case management model program
  C. hub-and-spoke model program
  D. group clinic model program
  B. case management model program

• Question 152:

  The following statement(s) can correctly be made about medical management considerations for the Federal Employee Health Benefits Program (FEHBP):

  1.FEHBP plan members who have exhausted the health plan's usual appeals process for a disputed decision can request an independent review by the Office of Personnel Management (OPM)

  2.All health plans that cover federal employees are required to develop and implement patient safety initiatives

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

• Question 153:

  The Medicaid population can be divided into subgroups based on their relative size and the costs of providing benefits. From the answer choices below, select the response that correctly identifies the subgroups that represent the largest percentages of the total Medicaid population and of total Medicaid expenditures. Largest % of Medicaid Population- Largest % of Medicaid Expenditures-

  A. Largest % of Medicaid Population-dual eligibles Largest % of Medicaid Expenditures- children and low-income adults
  B. Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for MedicareLargest % of Medicaid Expenditures-dual eligibles
  C. Largest % of Medicaid Population-children and low-income adults Largest % of Medicaid Expenditures-chronically ill or disabled individuals not eligible for Medicare
  D. Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for Medicare Largest % of Medicaid Expenditures-children and low-income adults
  C. Largest % of Medicaid Population-children and low-income adults Largest % of Medicaid Expenditures-chronically ill or disabled individuals not eligible for Medicare

• Question 154:

  Determine whether the following statement is true or false:

  Immunization programs are a direct means of reducing health plan members' needs for healthcare services and are typically cost-effective.

  A. True
  B. False
  A. True

• Question 155:

  One true statement about state regulation of case management activities is that the majority of states

  A. have enacted laws that list specific quality management requirements for a case management program
  B. consider case management files to be medical records that must be retained for a specified length of time
  C. view case management similarly and follow similar patterns with their laws and regulations
  D. have enacted laws or regulations requiring licensure or certification of case managers
  B. consider case management files to be medical records that must be retained for a specified length of time

• Question 156:

  Determine whether the following statement is true or false:

  Independent review organizations (IROs) can mediate disputes and offer advisory opinions to health plans on UR issues, but they cannot render binding decisions on appeals.

  A. True
  B. False
  B. False

• Question 157:

  The Quality Assessment Performance Improvement (QAPI) is a quality initiative designed to strengthen health plans' efforts to protect and improve the health and satisfaction of Medicare and Medicaid health plan enrollees. The Centers for Medicare and Medicaid Services (CMS) requires compliance with QAPI from

  A. both Medicare+Choice plans and Medicaid health plans
  B. Medicare+Choice plans only
  C. Medicaid health plans only
  D. neither Medicare+Choice plans nor Medicaid health plans
  B. Medicare+Choice plans only

• Question 158:

  This agency oversees fraud and abuse matters as they relate to medical management.

  A. Health Resources and Services Administration (HRSA)
  B. Office of Personnel Management (OPM)
  C. Department of Health and Human Services (HHS)
  D. Department of Justice (DOJ)
  D. Department of Justice (DOJ)

• Question 159:

  One difference between outcomes research and clinical research is that outcomes research

  A. provides an absolute measure of treatment results, whereas clinical research provides a relative measure of results
  B. focuses on treatment effectiveness, whereas clinical research focuses on treatment efficacy
  C. examines diseases and treatments in isolation, whereas clinical research considers the effects of changes in health status and quality of life
  D. gathers outcomes data from controlled clinical trials, whereas clinical research collects and analyzes clinical, financial, and administrative data
  B. focuses on treatment effectiveness, whereas clinical research focuses on treatment efficacy

• Question 160:

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

  A. The use of a signed consent authorization form is consistent with accrediting agency standards for patient privacy and confidentiality of medical information.
  B. Case management that is initiated after a member has incurred substantial medical expenses is more likely to be viewed as a tool to cut costs rather than to improve outcomes.
  C. Health plan documents indicating that any case management delegates are separate, independent entities may reduce an health plan's exposure to risk.
  D. A case management file cannot be used to support the health plan's position in the event of a lawsuit.
  D. A case management file cannot be used to support the health plan's position in the event of a lawsuit.