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AHIP AHM-540 Actual Questions

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Question 8

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

Options:

A.

coordinated outreach model program

B.

case management model program

C.

hub-and-spoke model program

D.

group clinic model program

Question 9

This agency oversees fraud and abuse matters as they relate to medical management.

Options:

A.

Health Resources and Services Administration (HRSA)

B.

Office of Personnel Management (OPM)

C.

Department of Health and Human Services (HHS)

D.

Department of Justice (DOJ)

Question 10

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

Each quality standard used by a health plan is associated with quality indicators. A ______________ indicator is a form of aggregate data indicator that produces results that fit within a specified range, such as the length of time to schedule an appointment.

Options:

A.

yes/no

B.

sentinel event

C.

discrete variable

D.

continuous variable

Question 11

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

Ways that workers’ compensation health plans can help control the costs of job-related injuries and illnesses include

Options:

A.

applying strict definitions of medical necessity

B.

developing prevention and recovery programs

C.

applying out-of-network benefit reductions

D.

all of the above

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Exam Code: AHM-540
Exam Name: Medical Management
Last Update: Nov 21, 2024
Questions: 163
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