AHIP AHM-540 Online Practice Questions and Exam Preparation

AHIP AHM-540 Online Questions & Answers

• Question 81:

  A health plan's preventive care initiatives may be classified into three main categories:

  primary prevention, secondary prevention, and tertiary prevention. Secondary prevention refers to activities designed to

  A. develop an appropriate treatment strategy for patients whose conditions require extensive, complex healthcare
  B. educate and motivate members to prevent illness through their lifestyle choices
  C. prevent the occurrence of illness or injury
  D. detect a medical condition in its early stages and prevent or at least delay disease progression and complications
  D. detect a medical condition in its early stages and prevent or at least delay disease progression and complications

• Question 82:

  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
  D. case assessment

• Question 83:

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

  To manage the delivery of healthcare services to their members, health plans use clinical practice parameters. ___________________ is the type of clinical practice parameter that a health plan uses to make coverage decisions concerning medical necessity and appropriateness.

  A. A clinical practice guideline (CPG)
  B. Medical policy
  C. Benefits administration policy
  D. A standard of care
  B. Medical policy

• Question 84:

  The paragraph below contains two pairs of terms enclosed in parentheses. Select the term in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.

  Under a delegation arrangement, the (delegate / delegator) is responsible for performing the delegated function according to established standards, and the (delegate / delegator) is ultimately accountable for any deficiencies in the performance of the function.

  A. delegate / delegate
  B. delegate / delegator
  C. delegator / delegate
  D. delegator / delegator
  B. delegate / delegator

• Question 85:

  Occasionally, employers combine workers' compensation, group healthcare, and disability programs into an integrated product known as 24-hour coverage. One true statement about 24-hour coverage is that it typically

  A. increases administrative costs
  B. requires plans to maintain separate databases of patient care information
  C. exempts plans from complying with state workers' compensation regulations
  D. allows plans to apply disability management and return-to-work techniques to nonoccupational conditions
  D. allows plans to apply disability management and return-to-work techniques to nonoccupational conditions

• Question 86:

  Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the

  A. lack of qualified providers in provider networks
  B. lack of resources necessary to establish case management programs for patients with complex conditions
  C. unstable eligibility status of Medicaid recipients
  D. inability of Medicaid recipients to change health plans or PCPs
  C. unstable eligibility status of Medicaid recipients

• Question 87:

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

• Question 88:

  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
  A. Mr. Farrell and his family

• Question 89:

  Three general categories of coverage policy--medical policy, benefits administration policy, and administrative policy--are used in conjunction with purchaser contracts to determine a health plan's coverage of healthcare services and supplies. With respect to the characteristics of the three types of coverage policy, it is correct to say that a health plan's

  A. medical policy evaluates clinical services against specific benefits language rather than against scientific evidence
  B. benefits administration policy determines whether a particular service is experimental or investigational
  C. benefits administration policy focuses on both clinical and nonclinical coverage issues
  D. administrative policy contains the guidelines to be followed when handling member and provider complaints and disputes
  D. administrative policy contains the guidelines to be followed when handling member and provider complaints and disputes

• Question 90:

  With respect to the activities of MCO medical directors, it is correct to say that medical directors typically perform all of the following activities EXCEPT

  A. maintaining clinical practices
  B. delivering performance feedback to providers
  C. participating in utilization management (UM) activities
  D. educating other MCO staff about new clinical developments or provider innovations that might impact clinical practice management
  A. maintaining clinical practices