AHIP AHIP Certification AHM-540 Questions & Answers

• Question 41:

  The Westchester Health Plan classifies its key processes into the following categories: high-risk, high-volume, problem-prone, and high-cost. Westchester also prioritizes the categories in terms of importance. The process category that Westchester most likely ranks highest in importance is

  A. High-risk processes

  B. High-volume processes

  C. Problem-prone processes

  D. High-cost processes

  Correct Answer: A

• Question 42:

  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

  Correct Answer: D

• Question 43:

  The BBA of 1997 allows states to provide Medicaid benefits to children through the State Children's Health Insurance Program (SCHIP). Under the terms of the BBA, states can implement SCHIP as 1.Part of their existing Medicaid programs 2.Separate commercial insurance programs

  A. Both 1 and 2

  B. 1 only

  C. 2 only

  D. Neither 1 nor 2

  Correct Answer: A

• Question 44:

  In order to provide a true measure of quality, the data collected by a quality indicator should accurately represent the service dimension being measured. This information indicates that the indicator should exhibit the characteristic known as

  A. clarity

  B. reliability

  C. validity

  D. feasibility

  Correct Answer: C

• Question 45:

  Vision care is typically separated into two categories: routine eye care and clinical eye care. The standard benefit plans offered by most health plans include coverage for 1.Routine eye care 2.Clinical eye care

  A. Both 1 and 2

  B. 1 only

  C. 2 only

  D. Neither 1 nor 2

  Correct Answer: C

• Question 46:

  Various government and independent agencies have created tools to measure and report the quality of healthcare. One performance measurement tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) is

  A. the Health Plan Employer Data and Information Set (HEDIS?, which is a report card system for hospitals and long-term care facilities

  B. HEDIS, which is a performance measurement tool that addresses both effectiveness of care and plan member satisfaction

  C. the Consumer Assessment of Health Plans (CAHPS?, which was established to develop and implement a national strategy for quality measurement and reporting

  D. CAHPS, which is a tool that measures consumer satisfaction with specific aspects of health plan services

  Correct Answer: D

• Question 47:

  Many health plans use HRA to target their preventive care programs to the healthcare needs of their members. With regard to HRA, it is correct to say that

  A. Health plans rarely delegate HRA activities to external entities

  B. Health plans typically focus their HRA efforts on newly enrolled members

  C. HRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members

  D. HRA is generally a reliable predictor of medical resource utilization

  Correct Answer: B

• Question 48:

  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)

  Correct Answer: C

• Question 49:

  The delivery of quality, cost-effective healthcare is a primary goal of both group healthcare and workers' compensation programs. One difference between group healthcare and workers' compensation is that workers' compensation

  A. provides health and disability benefits to employees injured on the job only if the employer is at fault for the injury

  B. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs

  C. manages costs by including employee cost-sharing features in its benefit design

  D. places limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits

  Correct Answer: B

• Question 50:

  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.

  Correct Answer: D