AHM-540 Exam Dumps - AHIP Certification Questions and Answers

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Questions 4

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.

Options:

A clinical practice guideline (CPG)

Medical policy

Benefits administration policy

A standard of care

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Questions 5

The following statements are about risk management for case management. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

Options:

The use of a signed consent authorization form is consistent with accrediting agency standards for patient privacy and confidentiality of medical information.

Case management that is initiated after a member has incurred substantial medical expenses is more likely to be viewed as a tool to cut costs rather than to improve outcomes.

Health plan documents indicating that any case management delegates are separate, independent entities may reduce an health plan's exposure to risk.

A case management file cannot be used to support the health plan's position in the event of a lawsuit.

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Questions 6

The Medicaid population can be divided into subgroups based on their relative size and the costs of providing benefits. From the answer choices below, select the response that correctly identifies the subgroups that represent the largest percentages of the total Medicaid population and of total Medicaid expenditures. Largest % of Medicaid Population- Largest % of Medicaid Expenditures-

Options:

Largest % of Medicaid Population-dual eligibles Largest % of Medicaid Expenditures-children and low-income adults

Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for MedicareLargest % of Medicaid Expenditures-dual eligibles

Largest % of Medicaid Population-children and low-income adults Largest % of Medicaid Expenditures-chronically ill or disabled individuals not eligible for Medicare

Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for Medicare Largest % of Medicaid Expenditures-children and low-income adults

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Questions 7

Determine whether the following statement is true or false:

The delegation of medical management functions to providers can occur without the transfer of financial risk.