Pre-Summer Special Limited Time 70% Discount Offer - Ends in 0d 00h 00m 00s - Coupon code = getmirror

Home
AHIP
AHIP Certification
AHM-540
Medical Management Questions and Answers

Pass the AHIP Certification AHM-540 Questions and answers with ExamsMirror

Practice at least 50% of the questions to maximize your chances of passing.

Exam AHM-540 Premium Access

View all detail and faqs for the AHM-540 exam

Go to Exam

800 Students Passed

94% Average Score

96% Same Questions

Viewing page 3 out of 5 pages

Viewing questions 21-30 out of questions

Questions # 21:

The Garnet Health Plan uses provider profiling to measure and improve provider performance. Provider profiling most likely allows Garnet to

Options:

evaluate all providers without considering differences in risk

focus on specific clinical decisions of Garnet’s providers rather than on patterns of care

identify the outliers and high-value providers in its provider network

measure the effectiveness, but not the efficiency, of Garnet’s providers

Answer

Questions # 22:

Recent laws and regulations have established new requirements for Medicaid eligibility. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 affected Medicaid eligibility by

Options:

severing the link between Medicaid and public assistance

eliminating the need for applications for Medicaid and public assistance

allowing states to provide healthcare benefits to groups outside the traditional Medicaid population

providing supplemental funding for dual eligibles in the form of five-year block grants

Answer

Questions # 23:

The following statements are about QAPI as it applies to Medicare+Choice plans and Medicaid health plan entities. Select the answer choice containing the correct statement.

Options:

QAPI provides separate sets of standards for Medicaid MCEs and Medicare+Choice plans.

Medicaid primary care case management (PCCM) programs are required to comply with all QAPI standards.

QISMC standards for quality measurement and improvement apply only to clinical services delivered to Medicare and Medicaid enrollees.

States that require Medicaid MCEs to comply with QAPI standards are considered to be in compliance with CMS quality assessment and improvement regulations.

Answer

Questions # 24:

To see that utilization guidelines are consistently applied, UR programs rely on authorization systems. Determine whether the following statement about authorization systems is true or false:

Only physicians can make nonauthorization decisions based on medical necessity.

Options:

True

False

Answer

Questions # 25:

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

Options:

Health Resources and Services Administration (HRSA)

Office of Personnel Management (OPM)

Department of Health and Human Services (HHS)

Department of Justice (DOJ)

Answer

Questions # 26:

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

Options:

remove behavioral healthcare services from the primary care setting

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

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

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

Answer

Questions # 27:

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

Options:

develop an appropriate treatment strategy for patients whose conditions require extensive, complex healthcare

educate and motivate members to prevent illness through their lifestyle choices

prevent the occurrence of illness or injury

detect a medical condition in its early stages and prevent or at least delay disease progression and complications

Answer

Questions # 28:

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

Options:

Both 1 and 2

1 only

2 only

Neither 1 nor 2

Answer

Questions # 29:

In order for a health plan’s performance-based quality improvement programs to be effective, the desired outcomes must be

Options:

achievable within a specified timeframe

defined in terms of multiple results

expressed in subjective, qualitative terms

all of the above

Answer

Questions # 30:

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-