AHIP AHIP Certifications AHM-540 Questions & Answers

• Question 81:

  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)

  Correct Answer: D

• Question 82:

  The Shoreside Health Plan recently added coverage for behavioral healthcare services to its benefit package. In order to support the quality of its behavioral healthcare services, Shoreside plans to seek accreditation for its behavioral healthcare program. Accreditation specifically designed for behavioral healthcare programs is available through 1.The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

  2.The National Committee for Quality Assurance (NCQA)

  3.The American Accreditation HealthCare Commission/URAC (URAC)

  A. All of the above

  B. 1 and 2 only

  C. 2 and 3 only

  D. 1 only

  Correct Answer: B

• Question 83:

  To improve members' abilities to make appropriate care decisions about specific medical problems, some health plans use a form of decision support known as telephone triage programs. The following statements are about telephone triage programs. Select the answer choice containing the correct statement.

  A. The primary role of telephone triage clinical staff is to diagnose the caller's condition and give medical advice.

  B. Quality management (QM) for telephone triage programs typically focuses on the clinical information provided rather than on the quality of service.

  C. Currently, none of the major accrediting agencies offers an accreditation program specifically for telephone triage programs.

  D. A telephone triage program may also include a self-care component.

  Correct Answer: B

• Question 84:

  For this question, if answer choices (a) through (c) are all correct, select answer choice (d). Otherwise, select the one correct answer choice.

  Well-crafted clinical practice guidelines (CPGs) can benefit healthcare delivery processes and outcomes by

  A. providing a framework for care while also allowing for patient-specific variations, based on physician judgment

  B. serving as a basis for evaluating whether providers are practicing in accordance with accepted standards

  C. focusing on the prevention or early detection of a particular condition

  D. all of the above

  Correct Answer: D

• Question 85:

  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

  Correct Answer: D

• Question 86:

  Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

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

  Decisions regarding Mr. Farrell's end-of-life care are legally the right and responsibility of

  A. Mr. Farrell and his family

  B. Mr. Farrell's physician

  C. Mr. Farrell's health plan

  D. All of the above

  Correct Answer: A

• Question 87:

  The following statements are about the use of provider profiling for pharmacy benefits. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  A. Health plans typically use provider profiles to improve the quality of care associated with the use of prescription drugs.

  B. Provider profiles identify prescribing patterns that fall outside normal ranges.

  C. Health plans can motivate providers to change their prescribing patterns by sharing profile information with plan members and the general public.

  D. Provider profiles are effective in modifying individual prescribing patterns, but they have little effect on group prescribing patterns.

  Correct Answer: D

• Question 88:

  Determine whether the following statement is true or false:

  All health plans participating in the Federal Employee Health Benefits Program (FEHBP) are required to use the Consumer Assessment of Health Plans (CAHPS) to measure customer satisfaction.

  A. True

  B. False

  Correct Answer: A

• Question 89:

  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

  Correct Answer: C

• Question 90:

  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

  Correct Answer: D