AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 11:

  For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

  Many health plans use data warehouses to assist with the performance of medical management activities. With respect to the characteristics of data warehouses, it is generally correct to say

  A. that the construction of a data warehouse is quick and simple
  B. that a data warehouse addresses the problems associated with multiple data management systems
  C. that a data warehouse stores only current data
  D. all of the above
  B. that a data warehouse addresses the problems associated with multiple data management systems

• Question 12:

  Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say

  A. that they are focused primarily on health maintenance organization (HMO) plans
  B. that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS) 3.0
  C. that they are used to rank the performance of various health plans
  D. all of the above
  D. all of the above

• Question 13:

  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
  A. activities of daily living / functional status

• Question 14:

  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.

  Due to competitive pressures and consumer demand, many health plans now offer direct access or open access products. Under a direct access product, a member is (required / not required) to select a primary care provider (PCP), and is (required / not required) to obtain a referral from a PCP or the health plan before visiting a network specialist.

  A. required / required
  B. required / not required
  C. not required / required
  D. not required / not required
  B. required / not required

• Question 15:

  Recent laws and regulations have established new requirements for Medicaid eligibility. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 affected Medicaid eligibility by

  A. severing the link between Medicaid and public assistance
  B. eliminating the need for applications for Medicaid and public assistance
  C. allowing states to provide healthcare benefits to groups outside the traditional Medicaid population
  D. providing supplemental funding for dual eligibles in the form of five-year block grants
  A. severing the link between Medicaid and public assistance

• Question 16:

  The Midwest Health Plan delegated utilization review (UR) activities to the Tri-City Utilization Review Organization. After Tri-City improperly recommended denial of payment for services to a Midwest plan member, the plan member filed suit. The court ruled that Midwest was responsible for Tri-City's actions because of the relationship between Midwest and Tri-City. This situation is an illustration of a legal concept known as

  A. vicarious liability
  B. fraud
  C. a tying arrangement
  D. subdelegation
  A. vicarious liability

• Question 17:

  For this question, if answer choices (a) through (c) are all correct, select answer choice (d). Otherwise, select the one correct answer choice. Well-crafted clinical practice guidelines (CPGs) can benefit healthcare delivery processes and outcomes by

  A. providing a framework for care while also allowing for patient-specific variations, based on physician judgment
  B. serving as a basis for evaluating whether providers are practicing in accordance with accepted standards
  C. focusing on the prevention or early detection of a particular condition
  D. all of the above
  D. all of the above

• Question 18:

  Patricia McLeod is a member of the Enterprise Health Plan, which operates in State X. Ms. McLeod is scheduled to undergo a unilateral mastectomy for the treatment of breast cancer. The surgical procedure will be performed by Dr. Kim Lee, a surgical oncologist. Based on Enterprise's medical policy, the contract with the purchaser, and Ms. McLeod's medical condition, Enterprise's UR staff have determined that the appropriate course of care for Ms.

  McLeod includes a 24-hour stay in the hospital following her surgery. State X, however, has a benefit mandate specifying health plan coverage for 48 hours of inpatient post- mastectomy care. In this situation, the length of hospital stay for which Enterprise must offer coverage is

  A. the length of stay deemed appropriate by Dr. Lee
  B. the 24-hour stay determined to be appropriate by Enterprise's UR staff
  C. the length of stay deemed appropriate by Ms. McLeod
  D. the 48-hour length of stay specified by State X
  D. the 48-hour length of stay specified by State X

• Question 19:

  By definition, the development and implementation of parameters for the delivery of healthcare services to a health plan's members is known as

  A. utilization management (UM)
  B. quality management (QM)
  C. care management
  D. clinical practice management
  D. clinical practice management

• Question 20:

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