AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 51:

  This agency has authority over Programs of All-inclusive Care for the Elderly (PACE) and the State Children's Health Insurance Program (SCHIP).

  A. Health Resources and Services Administration (HRSA)
  B. Office of Personnel Management (OPM)
  C. Department of Health and Human Services (HHS)
  D. Department of Justice (DOJ)
  C. Department of Health and Human Services (HHS)

• Question 52:

  One way that health plans can make their benefits more appealing to employers and employees is to offer coverage for specialty services. It is correct to say that specialty services typically

  A. involve the same types of providers and delivery systems as do standard medical services
  B. are a subset of a health plan's standard medical-surgical services
  C. are not monitored by health plans for quality or utilization
  D. require specialized knowledge for service delivery and management
  D. require specialized knowledge for service delivery and management

• Question 53:

  The Carlyle Health Plan uses the following clinical outcome measures to evaluate its diabetes and asthma disease management programs:

  Measure 1: The percentage of diabetic patients who receive foot exams from their providers according to the program's recommended guidelines Measure 2: The number of asthma patients who visited emergency departments for acute asthma attacks From the answer choices below, select the response that correctly identifies whether these measures are true outcome measures or intermediate outcome measures. Measure 1- Measure 2

  A. Measure 1-true outcome measure Measure 2-true outcome measure
  B. Measure 1-true outcome measure Measure 2-intermediate outcome measure
  C. Measure 1-intermediate outcome measure Measure 2-true outcome measure
  D. Measure 1-intermediate outcome measure Measure 2-intermediate outcome measure
  C. Measure 1-intermediate outcome measure Measure 2-true outcome measure

• Question 54:

  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.

  If Ms. Stanley agrees to the generic substitution, she will receive a drug that

  A. has not been tested for safety and efficacy in large clinical trials
  B. is available without a prescription at a reasonable cost
  C. has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective
  D. contains active ingredients that are identical to those of the prescribed brand-name drug
  D. contains active ingredients that are identical to those of the prescribed brand-name drug

• Question 55:

  The following statement(s) can correctly be made about the characteristics of peer review: 1.Peer review is applicable to either single episodes of care or to entire programs of care 2.Most peer review is conducted concurrently 3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans

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

• Question 56:

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

  The Balanced Budget Act (BBA) of 1997 established the use of ___________ to determine coverage of emergency services for Medicare and Medicaid enrollees in health plans.

  A. utilization management standards
  B. the prudent layperson standard
  C. preauthorization
  D. diagnosis-based retrospective review
  B. the prudent layperson standard

• Question 57:

  To facilitate electronic commerce (eCommerce), a health plan may establish a secured extranet. One true statement about a secured extranet is that it is

  A. based on Web-based technologies
  B. available only to the employees of the health plan
  C. publicly available, so the potential exists for unauthorized access to a health plan's proprietary systems
  D. used to handle the majority of health plan eCommerce
  A. based on Web-based technologies

• Question 58:

  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
  A. Both 1 and 2

• Question 59:

  Acute care refers to healthcare services for medical problems that

  A. are expected to continue for a minimum of 30 days
  B. are typically treated in a provider's office or outpatient facility
  C. require prompt, intensive treatment by healthcare providers
  D. require low utilization of resources
  C. require prompt, intensive treatment by healthcare providers

• Question 60:

  Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated care plans (CCPs). Unlike other coverage options, CCPs

  A. provide only those benefits covered by Medicare Part A and Part B
  B. are not subject to federal or state regulation
  C. place primary care at the center of the delivery system
  D. are structured as indemnity plans
  C. place primary care at the center of the delivery system