AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 21:

  Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.

  A. The proportion of adult members who are screened for hypertension will increase by ten percent.
  B. Primary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.
  C. The QM program director will evaluate the level of provider compliance with clinical practice guidelines (CPGs).
  D. The disease management program director will increase participation by asthmatic children in the health plan's pediatric asthma disease management program.
  B. Primary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.

• Question 22:

  The Garnet Health Plan uses provider profiling to measure and improve provider performance. Provider profiling most likely allows Garnet to

  A. evaluate all providers without considering differences in risk
  B. focus on specific clinical decisions of Garnet's providers rather than on patterns of care
  C. identify the outliers and high-value providers in its provider network
  D. measure the effectiveness, but not the efficiency, of Garnet's providers
  C. identify the outliers and high-value providers in its provider network

• Question 23:

  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 two terms or phrases that you have selected.

  The process for collecting and analyzing data differs for quality assessment (QA) and quality improvement (QI). For QA, data collection focuses on (objective / both objective and subjective) data, and data analysis identifies the (degree / cause) of variance.

  A. objective / degree
  B. objective / cause
  C. both objective and subjective / degree
  D. both objective and subjective / cause
  A. objective / degree

• Question 24:

  Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of

  A. case management
  B. geriatric evaluation and management (GEM)
  C. intervention identification
  D. interdisciplinary home care (IHC)
  C. intervention identification

• Question 25:

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

  A. True
  B. False
  B. False

• Question 26:

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

• Question 27:

  The following statements are about health plans' complaint resolution procedures (CRPs). Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. An health plan's CRPs reduce the likelihood of errors in decision making.
  B. CRPs typically provide for at least two levels of appeal for formal appeals.
  C. CRPs include only formal appeals and do not apply to informal complaints.
  D. Most complaints are resolved without proceeding through the entire CRP process.
  C. CRPs include only formal appeals and do not apply to informal complaints.

• Question 28:

  Health plan performance measures include structure measures, process measures, and outcome measures. The following statements are about the characteristics of these three types ofperformance measures. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. The most widely used structure measures relate to physician education and training.
  B. One advantage of structure measures over process measures is that structures are often linked directly to healthcare outcomes.
  C. Process measures are useful in identifying underuse, overuse, and inappropriate use of services.
  D. One disadvantage of outcome measures is that they can be influenced by factors outside the control of the health plan.
  B. One advantage of structure measures over process measures is that structures are often linked directly to healthcare outcomes.

• Question 29:

  Determine whether the following statement is true or false:

  With respect to the size of a managed care organization (MCO) and its medical management operations, it is correct to say that large health plans typically have more integration among activities and less specialization of roles than do small MCOs.

  A. True
  B. False
  B. False

• Question 30:

  Health plans arrange for the delivery of various levels of healthcare, including 1.Emergency care 2.Urgent care 3.Primary care delivered in a provider's office In a ranking of these levels of care according to cost, beginning with the least expensive level of care and ending with the most expensive level of care, the correct order would be

  A. 1--2--3
  B. 2--3--1
  C. 3--1--2
  D. 3--2--1
  D. 3--2--1