AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 41:

  Skilled nursing facilities (SNFs) are required by law to have formal programs for quality improvement and to monitor these programs using established standards. These requirements are described in 1.The Omnibus Budget Reconciliation Act (OBRA) of 1986 2.The Balanced Budget Act (BBA) of 1997

  A. Both 1 and 2
  B. 1 only
  C. 2 only
  D. Neither 1 or 2
  B. 1 only

• Question 42:

  Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement

  for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute.

  The paragraph below contains two pairs of terms enclosed 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.

  Greenhouse's prescription drug reimbursement policy indicates that the plan formulary is classified as (open / closed), and that compliance by patients and providers is (mandatory / voluntary).

  A. open / mandatory
  B. open / voluntary
  C. closed / mandatory
  D. closed / voluntary
  C. closed / mandatory

• Question 43:

  Patient safety and medical errors are important concerns for both quality management (QM) and risk management. The following statement(s) can correctly be made about medical errors: 1.The complexity of modern medicine and healthcare delivery systems increases patients' exposure to the risks of medical errors 2.Licensing boards for healthcare professionals in all states provide a consistent system of quality oversight and accountability 3.Provider compliance with internal incident reporting requirements is low

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

• Question 44:

  Many health plans use clinical pathways to help manage the delivery of acute care services to plan members. One true statement about clinical pathways is that they

  A. determine which healthcare services are medically necessary and appropriate for a particular patient in a particular situation
  B. outline the services that will be delivered, the providers responsible for delivering the services, the timing of delivery, the setting in which services are delivered, and the expected outcomes of the interventions
  C. cover only services delivered in an acute inpatient setting
  D. address medical conditions that affect a small segment of a given population and with which the majority of providers are unfamiliar
  B. outline the services that will be delivered, the providers responsible for delivering the services, the timing of delivery, the setting in which services are delivered, and the expected outcomes of the interventions

• Question 45:

  As a follow-up to a performance improvement plan for member services, the Stellar Health Plan conducted an evaluation of the success of the plan. Stellar conducted its evaluation as the plan was being carried out. The evaluation focused on specific activities and assessed the relative importance of those activities to the plan as a whole. This information indicates that Stellar's evaluation of the plan was both

  A. concurrent and formative
  B. concurrent and summative
  C. retrospective and formative
  D. retrospective and summative
  A. concurrent and formative

• Question 46:

  This agency's accreditation decisions are based on the results of an on-site survey of clinical and administrative systems and processes, as well as the health plan's performance on selected effectiveness of care and member satisfaction measures.

  A. American Accreditation HealthCare Commission/URAC (URAC)
  B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  C. Community Health Accreditation Program (CHAP)
  D. National Committee for Quality Assurance (NCQA)
  D. National Committee for Quality Assurance (NCQA)

• Question 47:

  The following statement(s) can correctly be made about accrediting agency standards for delegation:

  1.

  The National Committee for Quality Assurance (NCQA) allows health plans to delegate all medical management functions, including the responsibility to perform delegation oversight activities

  2.

  In some cases, accreditation standards for delegation oversight are reduced if the delegate has already been certified or accredited by the delegator's accrediting agency

  A. Both 1 and 2
  B. 1 only
  C. 2 only
  D. Neither 1 nor 2
  C. 2 only

• Question 48:

  In most health plans, the formulary system is developed and managed by a PandT committee. The PandT committee is responsible for

  A. evaluating and selecting drugs for inclusion in the formulary
  B. overseeing the manufacture, distribution, and marketing of prescription drugs
  C. certifying the medical necessity of expensive, potentially toxic, or nonformulary drugs
  D. all of the above
  A. evaluating and selecting drugs for inclusion in the formulary

• Question 49:

  The following statements are about the use of hospitalists to manage inpatient care. Select the answer choice containing the correct statement.

  A. A patient who has been transferred to a hospitalist for management of inpatient care usually continues to receive care from the hospitalist after discharge.
  B. Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.
  C. In order to serve as a hospitalist, a physician must have a background in critical care medicine.
  D. Hospitalists typically spend at least one-quarter of their time in a hospital setting.
  D. Hospitalists typically spend at least one-quarter of their time in a hospital setting.

• Question 50:

  The Noble Health Plan conducted a cost/benefit analysis of the following four prescription drugs:

  BenefitCost Drug A$525$350 Drug B$450$250 Drug C$400$200 Drug D$350$100 According to this analysis, the drug that represents the most efficient use of resources is

  A. Drug A
  B. Drug B
  C. Drug C
  D. Drug D
  D. Drug D