AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 31:

  Determine whether the following statement is true or false: Participation in disease management programs is currently voluntary.

  A. True
  B. False
  A. True

• Question 32:

  For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. In most commercial health plans, the case management process is directed by a case manager whose responsibilities typically include

  A. focusing on a disabled member's vocational rehabilitation and training
  B. approving all care decisions for patients under case management
  C. reducing the fragmentation of care that often results when individuals obtain services from several different providers
  D. all of the above
  C. reducing the fragmentation of care that often results when individuals obtain services from several different providers

• Question 33:

  To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data: 1.Patient surveys are the most widely used source of disease-specific clinical information 2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers 3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status

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

• Question 34:

  Nilay Sharma suffered a small wound while working in his yard and was taken to a local hospital for treatment. A triage nurse at the hospital evaluated Mr. Sharma's condition and directed him to an outpatient unit in the hospital where a physician assistant examined, cleaned, and sutured the wound. Mr. Sharma returned home following treatment. The care Mr. Sharma received at the hospital is an example of the type of care known as

  A. specialty referral
  B. primary prevention
  C. urgent care
  D. emergency care
  C. urgent care

• Question 35:

  Readiness is an important consideration for the development of health promotion programs. Readiness refers to

  A. the availability of previously established health promotion programs to an health plan's members through employers, providers, or community service agencies
  B. the appropriateness of a program's educational approach, given the language, literacy level, and cultural sensitivities of the target population
  C. a member's level of knowledge about existing health risks and problems and the member's ability and willingness to adopt new health-related behaviors
  D. a member's access to information technology, such as a video cassette recorder, a computer, or the Internet
  C. a member's level of knowledge about existing health risks and problems and the member's ability and willingness to adopt new health-related behaviors

• Question 36:

  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.

  The Millway Health Plan received a 15% reduction in the price of a particular pharmaceutical based on the volume of the drug Millway purchased from the manufacturer. This reduction in price is an example of a (rebate / price discount) and (is / is not) dependent on actual provider prescribing patterns.

  A. rebate / is
  B. rebate / is not
  C. price discount / is
  D. price discount / is not
  D. price discount / is not

• Question 37:

  The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.

  Each quality standard used by a health plan is associated with quality indicators. A ______________ indicator is a form of aggregate data indicator that produces results that fit within a specified range, such as the length of time to schedule an appointment.

  A. yes/no
  B. sentinel event
  C. discrete variable
  D. continuous variable
  D. continuous variable

• Question 38:

  Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

  A. must pay the entire cost of the examination
  B. must obtain a referral to a dentist from her primary care provider (PCP)
  C. can schedule the examination without preauthorization of payment by the DHMO
  D. can schedule an unlimited number of examinations and cleanings per year
  C. can schedule the examination without preauthorization of payment by the DHMO

• Question 39:

  Health plans that offer complementary and alternative medicine (CAM) services face potential liability because many types of CAM services

  A. must be offered as separate supplemental benefits or separate products
  B. lack clinical trials to evaluate their safety and effectiveness
  C. are not covered by state or federal consumer protection statutes
  D. focus on a specific illness, injury, or symptom rather than on the whole body
  B. lack clinical trials to evaluate their safety and effectiveness

• Question 40:

  MCOs usually have a formal program for the oversight of delegated activities. The following statements concern typical delegation oversight programs. Select the answer choice containing the correct statement.

  A. A letter of intent is the contractual document that describes the delegated functions and the responsibilities of the MCO and the delegate.
  B. In most cases, the evaluation of a candidate for delegation is based entirely on the candidate's application and supporting documentation and does not include an on-site assessment of the candidate.
  C. Under most delegation agreements, an MCO cannot terminate the agreement before the end date stated in the agreement.
  D. One objective for a delegation oversight program is to integrate any delegated activities into the MCO's overall programs for medical management and other functions.
  D. One objective for a delegation oversight program is to integrate any delegated activities into the MCO's overall programs for medical management and other functions.