AHIP AHIP Certification AHM-540 Questions & Answers

• Question 31:

  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

  Correct Answer: A

• Question 32:

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

  Health plans use both internal and external standards to assess the quality of the services that they provide. (Internal / External) standards are based on information such as published industry-wide averages or best practices of recognized industry leaders. Health plans primarily rely on (internal / external) standards to evaluate healthcare services.

  A. Internal / internal

  B. Internal / external

  C. External / internal

  D. External / external

  Correct Answer: D

• Question 33:

  The following statement(s) can correctly be made about utilization guidelines:

  1.When developing utilization guidelines, health plans balance evidence-based criteria with experience-based criteria

  2.Utilization guidelines indicate when a UR nurse should refer a decision to a physician reviewer

  A. Both 1 and 2

  B. 1 only

  C. 2 only

  D. Neither 1 nor 2

  Correct Answer: A

• Question 34:

  The following statements are about chronic and disabling conditions among children eligible for Medicaid. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. Children with chronic conditions use more physician and nonphysician professional services than do children in the general population.

  B. The majority of chronic conditions affecting children in Medicaid programs are the same as those affecting children in the general population.

  C. Medicaid-eligible children are at risk for seriousmental and physical conditions.

  D. Children in Medicaid programs have a higher incidence of chronic disabling conditions than do children in the general population.

  Correct Answer: B

• Question 35:

  7. One method that health plans use to address provider compliance with formularies is academic detailing.

  A. True

  B. False

  Correct Answer: A

• Question 36:

  Administrative action plans are used when performance problems or opportunities are related to the way the organization itself operates. The following statement(s) can correctly be made about administrative action plans:

  1.Administrative action plans allow health plans to coordinate management activities 2.One function of administrative action plans is to integrate service across all levels of the organization

  3.Administrative action plans are designed to improve outcomes by helping plan members assume responsibility for their own health

  A. All of the above

  B. 1 and 2 only

  C. 1 and 3 only

  D. 2 and 3 only

  Correct Answer: B

• Question 37:

  Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQA. These NCQA credentialing standards apply to

  A. chiropractors

  B. naturopaths

  C. acupuncturists

  D. all of the above

  Correct Answer: A

• Question 38:

  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.

  In this situation, the prescribing of Upzil for Ms. Ray's headaches is an example of

  A. a cosmetic service

  B. an investigational service

  C. an off-label use

  D. a quality-of-life service

  Correct Answer: C

• Question 39:

  The Hall Health Plan gathered objective clinical information about the recommended uses and dosages of angiotensin-converting enzyme (ACE) inhibitors and presented the information to network providers to illustrate the appropriate use of these frequently prescribed and expensive drugs. This information indicates that Hall most likely educated its network providers through the use of

  A. detailing

  B. cognitive services

  C. counter detailing

  D. drug efficacy study implementation (DESI)

  Correct Answer: C

• Question 40:

  Emilio Martinez, a member of the Bloom Health Plan, has recently been diagnosed with prostate cancer by his physician, Dr. Robert Cohen. Mr. Martinez has decided to participate in Bloom's shared decision-making program for prostate cancer. On the basis of this information, it is most likely correct to say

  1.That verification of Mr. Martinez's understanding about his care options protects both Dr. Cohen and Bloom against charges of malpractice

  2.That Mr. Martinez and Dr. Cohen will discuss the care options available to Mr. Martinez, but the ultimate decision about care is up to Dr. Cohen

  A. Both 1 and 2

  B. 1 only

  C. 2 only

  D. Neither 1 nor 2

  Correct Answer: D