AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 61:

  The following statements are about health plans' use of electronic data interchange (EDI). Three of the statements are true and one is false. Select the answer choice containing the FALSE ALSE statement.

  A. One advantage of EDI over manual data management systems is improved data integrity.
  B. EDI may use the Internet as the communication link between the participating parties.
  C. EDI involves back-and-forth exchanges of information concerning individual transactions.
  D. The data format for EDI is agreed upon by the sending and receiving parties.
  C. EDI involves back-and-forth exchanges of information concerning individual transactions.

• Question 62:

  For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. Ways that workers' compensation health plans can help control the costs of job-related injuries and illnesses include

  A. applying strict definitions of medical necessity
  B. developing prevention and recovery programs
  C. applying out-of-network benefit reductions
  D. all of the above
  B. developing prevention and recovery programs

• Question 63:

  State governments serve as both regulators and purchasers of health plan services. The influence of state governments as purchasers is focused on

  A. Medicare and TRICARE programs
  B. Medicaid and workers' compensation programs
  C. Medicare and Medicaid programs
  D. TRICARE and workers' compensation programs
  B. Medicaid and workers' compensation programs

• Question 64:

  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
  C. 2 only

• Question 65:

  The following statements are about medical management considerations for dental care. Select the answer choice containing the correct statement.

  A. Managed dental care organizations are regulated at the state rather than the federal level.
  B. Dental care differs from medical care in that most dental care is provided by specialists.
  C. Dental preferred provider organizations (Dental PPOs) are subject to more regulation than are dental health maintenance organizations (DHMOs).
  D. Managed dental plans are accredited by the National Association of Dental Plans (NADP).
  A. Managed dental care organizations are regulated at the state rather than the federal level.

• Question 66:

  A health plan's choice of structure measures, process measures, and outcome measures to evaluate performance depends in part on the scientific soundness of the measures. One approach that a health plan can use to enhance scientific soundness is stratification, which refers to the

  A. identification and removal of unusual cases, such as patients with contraindications to a particular treatment, from consideration
  B. statistical adjustment of outcome measures to account for differences in the severity of illness or the presence of other medical conditions
  C. specification of a target population for a procedure and the data collection and analysis methods to be used
  D. elimination of variation within a patient population by dividing the population into groups that are at a similar level of risk
  D. elimination of variation within a patient population by dividing the population into groups that are at a similar level of risk

• Question 67:

  Elaine Newman suffered an acute asthma attack and was taken to a hospital emergency department for treatment. Because Ms. Newman's condition had not improved enough following treatment to warrant immediate release, she was transferred to an observation care unit. Transferring Ms. Newman to the observation care unit most likely

  A. resulted in unnecessarily expensive charges for treatment
  B. prevented Ms. Newman from receiving immediate attention for her condition
  C. gave Ms. Newman access to more effective and efficient treatment than she could have obtained from other providers in the same region
  D. allowed clinical staff an opportunity to determine whether Ms. Newman required hospitalization without actually admitting her
  D. allowed clinical staff an opportunity to determine whether Ms. Newman required hospitalization without actually admitting her

• Question 68:

  The following statements are about the characteristics of a utilization review (UR) program. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. A primary goal of UR is to address practice variations through the application of uniform standards and guidelines.
  B. UR evaluates whether the services recommended by a member's provider are covered under the benefit plan.
  C. UR recommends the procedures that providers should perform for plan members.
  D. A health plan's UR program is usually subject to review and approval by the state insurance and/or health departments.
  C. UR recommends the procedures that providers should perform for plan members.

• Question 69:

  DUR can be conducted prospectively, concurrently, or retrospectively. One true statement about prospective DUR is that it

  A. involves periodic audits of the medical records of a certain group of patients
  B. is based on historical data
  C. focuses on the drug therapy for a single patient rather than overall usage patterns
  D. is conducted by physicians, without input from pharmacists
  C. focuses on the drug therapy for a single patient rather than overall usage patterns

• Question 70:

  The Brighton Health Plan regularly performs prospective UR for surgical procedures. Brighton's prospective UR activities are likely to include

  A. documenting the clinical details of the patient's condition and care
  B. tracking the length of inpatient stay
  C. completing the discharge planning process
  D. determining the most appropriate setting for the proposed course of care
  D. determining the most appropriate setting for the proposed course of care