AHIP AHIP Certifications AHM-540 Questions & Answers

• Question 51:

  Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.

  A. The proportion of adult members who are screened for hypertension will increase by ten percent.

  B. Primary care providers (PCPs) will increase the proportion of children under the age of two who are upto-date on immunizations by seven percent within one year.

  C. The QM program director will evaluate the level of provider compliance with clinical practice guidelines (CPGs).

  D. The disease management program director will increase participation by asthmatic children in the health plan's pediatric asthma disease management program.

  Correct Answer: B

• Question 52:

  Health plans have a specified number of working days to respond to Level One appeals, as stated by company policy or regulatory requirements. With regard to the timeframes for appeals, it is generally correct to say

  1.That the typical timeframe requires a health plan to respond to appeals in fewer than 20 days 2.That the timeframe is accelerated for expedited appeals 3.That the review period begins when the appeal arrives at a health plan

  A. All of the above

  B. 1 and 2 only

  C. 1 and 3 only

  D. 2 and 3 only

  Correct Answer: D

• Question 53:

  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)

  Correct Answer: C

• Question 54:

  Performance variance can be classified as either common cause variance or special cause variance. The following statement(s) can correctly be made about special cause variance:

  1.Inadequate staffing levels, employee errors, and equipment malfunctions are examples of special cause variance 2.Special cause variance is typically more difficult to detect and correct than is common cause variance

  A. Both 1 and 2

  B. 1 only

  C. 2 only

  D. Neither 1 nor 2

  Correct Answer: B

• Question 55:

  The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to

  A. remove behavioral healthcare services from the primary care setting

  B. shift behavioral healthcare from acute inpatient settings to alternative settings when feasible

  C. reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient

  D. offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members

  Correct Answer: B

• Question 56:

  The Strathmore Health Plan uses clinical pathways to manage its acute care services. In order to reduce the risk of financial liability associated with the use of clinical pathways, Strathmore and its network hospitals should

  A. base pathways on relevant evidence reported in medical literature

  B. restrict each pathway to a single medical condition

  C. use pathways to establish a new standard of care

  D. allow providers to use only those interventions listed in the pathways

  Correct Answer: A

• Question 57:

  For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

  The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans' efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

  A. standard medical-surgical services

  B. mental health and substance abuse services

  C. services offered to Medicare enrollees as optional supplementary benefits

  D. all of the above

  Correct Answer: D

• Question 58:

  Selene Varga is participating in her health plan's disease management program for congestive heart failure. Ms. Varga's health status is regularly monitored and managed by a licensed nurse who visits Ms. Varga at her home to administer treatment and assess the need for changes in Ms. Varga's overall care plan. This information indicates that Ms. Varga is participating in the type of disease management program known as a

  A. coordinated outreach model program

  B. case management model program

  C. hub-and-spoke model program

  D. group clinic model program

  Correct Answer: B

• Question 59:

  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

  Correct Answer: B

• Question 60:

  Breanna Osborn is a case manager for a regional health plan. One component of Ms. Osborn's job is the collection and evaluation of medical, financial, social, and psychosocial information about a member's situation. This component of Ms. Osborn's job is known as

  A. case identification

  B. case management planning

  C. healthcare coordination

  D. case assessment

  Correct Answer: D