AHIP Medical Management - AHM-540 FREE EXAM DUMPS QUESTIONS & ANSWERS]

Question 1

The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.
Definitions of quality healthcare vary; however, four dimensions are essential to quality healthcare services. ________________ is the quality dimension indicating that services result in the best care for a given cost or the lowest cost for a given level of care.

A. Acceptability B. Efficiency C. Accessibility D. Effectiveness

Discussion 0

Correct Answer: B Vote an answer

Question 2

One of the steps in drug utilization review (DUR) is defining optimal drug use, which can be accomplished by applying diagnosis criteria and drug-specific criteria. Drug-specific criteria are standards that identify the

A. cost-effectiveness of all possible drug treatments for a particular condition B. actual prescribing and dispensing patterns for a particular drug C. appropriate dosages, duration of treatment, and other elements related to the use of a particular drug D. types of diseases, conditions, or patients for which a drug should be used

Discussion 0

Correct Answer: C Vote an answer

Question 3

To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data:
1.Patient surveys are the most widely used source of disease-specific clinical information
2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers
3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status

A. 2 and 3 only B. All of the above C. 1 and 2 only D. 3 only

Discussion 0

Correct Answer: A Vote an answer

Question 4

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 assessment C. case management planning D. healthcare coordination

Discussion 0

Correct Answer: B Vote an answer

Question 5

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. hub-and-spoke model program B. case management model program C. group clinic model program D. coordinated outreach model program

Discussion 0

Correct Answer: B Vote an answer

Question 6

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

A. can schedule an unlimited number of examinations and cleanings per year B. can schedule the examination without preauthorization of payment by the DHMO C. must obtain a referral to a dentist from her primary care provider (PCP) D. must pay the entire cost of the examination

Discussion 0

Correct Answer: B Vote an answer

Question 7

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

Discussion 0

Correct Answer: A Vote an answer

Question 8

Many health plans use HRA to target their preventive care programs to the healthcare needs of their members. With regard to HRA, it is correct to say that

A. Health plans rarely delegate HRA activities to external entities B. HRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members C. HRA is generally a reliable predictor of medical resource utilization D. Health plans typically focus their HRA efforts on newly enrolled members

Discussion 0

Correct Answer: D Vote an answer

Question 9

Acute care refers to healthcare services for medical problems that

A. require low utilization of resources B. are typically treated in a provider's office or outpatient facility C. require prompt, intensive treatment by healthcare providers D. are expected to continue for a minimum of 30 days

Discussion 0

Correct Answer: C Vote an answer

Question 10

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

Discussion 0

Correct Answer: B Vote an answer