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AHM-540 Reviews Questions

Page: 5 / 5
Question 20

To facilitate electronic commerce (eCommerce), a health plan may establish a secured extranet. One true statement about a secured extranet is that it is

Options:

A.

based on Web-based technologies

B.

available only to the employees of the health plan

C.

publicly available, so the potential exists for unauthorized access to a health plan’s proprietary systems

D.

used to handle the majority of health plan eCommerce

Question 21

Economically, health plans cannot provide coverage for every drug available from every manufacturer. As a result, purchaser contracts often include provisions specifying that certain drugs or drug types will not be covered. These provisions are referred to as

Options:

A.

limitations

B.

exceptions

C.

exclusions

D.

drug edits

Question 22

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:

A.

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

B.

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.

C.

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

D.

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

Question 23

The following statement(s) can correctly be made about the use of screening for secondary prevention:

1. Screening activities may involve specialty care providers as well as primary care providers (PCPs) and the health plan

2. Secondary prevention often results in more utilization of services immediately following screening

3. Screening focuses on members who have not experienced any symptoms of a particular illness

Options:

A.

All of the above

B.

1 and 3 only

C.

2 and 3 only

D.

1 only

Page: 5 / 5
Exam Code: AHM-540
Exam Name: Medical Management
Last Update: Nov 21, 2024
Questions: 163
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