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AHM-540 Exam

AHM Medical Management Exam

  • Exam Number/Code : AHM-540
  • Exam Name : AHM Medical Management Exam
  • Questions and Answers : 162 Q&As
  • Update Time: 2017-09-13
  • Price: $ 99.00 $ 39.00

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Exam Description or Exam Demo

Exam code : AHM-540

Exam name : Medical Management
One method of transferring the information in electronic medical records (EMRs) is through
a health information network (HIN). The following statements are about HINs. Three of the
statements are true and one is false. Select the answer choice containing the FALSE
A. A HIN may afford a health plan better measurements of outcomes and provider
B. The use of a HIN typically increases a health plan’s exposure to liability for poor care.
C. Most HINs are Internet-based rather than built on proprietary computer networks.
D. Currently, the majority of health plans do not have HINs that are capable of transferring
medical records among their network providers.
Answer: B
One true statement about state regulation of case management activities is that the
majority of states
A. have enacted laws that list specific quality management requirements for a case
management program
B. consider case management files to be medical records that must be retained for a
specified length of time
C. view case management similarly and follow similar patterns with their laws and
D. have enacted laws or regulations requiring licensure or certification of case managers
Answer: B
CMS has developed two prototype programs—Programs of All-inclusive Care for the
Elderly (PACE) and the Social Health Maintenance Organization (SHMO) demonstration
project—to deliver healthcare services to Medicare beneficiaries. From the answer choices
below, select the response that correctly identifies the features of these programs.
A. PACE-annual limits on benefits for nursing home and community-based care SHMO-no
limits on long-term care benefits
B. PACE-provide long-term care only SHMO-provide acute and long-term care
C. PACE-enrollees must be age 65 or older SHMO-enrollees must be age 55 or older
D. PACE-enrollment open to nursing home certifiable Medicare beneficiaries only SHMOenrollment
open to all Medicare beneficiaries
Answer: D
The American Accreditation HealthCare Commission/URAC (URAC) has an accreditation
program specifically for case management services. From the answer choices below,
select the response that correctly identifies the type(s) of case management services
addressed by URAC’s standards and the type(s) of organizations to which these standards
may be applied.
A. Type(s) of Services-on-site services only Type(s) of Organization-health plans only
B. Type(s) of Services-on-site services only Type(s) of Organization-any organization that
performs case management functions
C. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-health
plans only
D. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-any
organization that performs case management functions
Answer: D
The paragraph below contains an incomplete statement. Select the answer choice
containing the term that correctly completes the paragraph.
Medical management programs often require the analysis of many types of data and
information. __________________ is an automated process that analyzes variables to help
detect patterns and relationships in the data.
A. Unbundling
B. Outsourcing
C. Data mining
D. Drilling down
Answer: C
Elaine Newman suffered an acute asthma attack and was taken to a hospital emergency
department for treatment. Because Ms. Newman’s condition had not improved enough
following treatment to warrant immediate release, she was transferred to an observation
care unit. Transferring Ms. Newman to the observation care unit most likely
A. resulted in unnecessarily expensive charges for treatment
B. prevented Ms. Newman from receiving immediate attention for her condition
C. gave Ms. Newman access to more effective and efficient treatment than she could have
obtained from other providers in the same region
D. allowed clinical staff an opportunity to determine whether Ms. Newman required
hospitalization without actually admitting her
Answer: D
The following statements describe situations in which health plan members have medical
problems that require care. Select the statement that describes a situation in which selfcare
most likely would not be appropriate.
A. Two days after bruising her leg, Avis Bennet notices that the pain from the bruise has
increased and that there are red streaks and swelling around the bruised area.
B. Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several
times each day.
C. Caroline Evans has severe arthritis that requires regular exercise and oral medication to
reduce pain and help her maintain mobility.
D. Oscar Gracken is recovering from a heart attack and requires ongoing cardiac
Answer: A
The following statement(s) can correctly be made about medical management
considerations for the Federal Employee Health Benefits Program (FEHBP):
1.FEHBP plan members who have exhausted the health plan’s usual appeals process for a
disputed decision can request an independent review by the Office of Personnel
Management (OPM)
2.All health plans that cover federal employees are required to develop and implement
patient safety initiatives
A. Both 1 and 2
B. 1 only
C. 2 only
D. Neither 1 nor 2
Answer: A
Three general categories of coverage policy—medical policy, benefits administration policy,
and administrative policy—are used in conjunction with purchaser contracts to determine a
health plan’s coverage of healthcare services and supplies. With respect to the
characteristics of the three types of coverage policy, it is correct to say that a health plan’s
A. medical policy evaluates clinical services against specific benefits language rather than
against scientific evidence
B. benefits administration policy determines whether a particular service is experimental or
C. benefits administration policy focuses on both clinical and nonclinical coverage issues
D. administrative policy contains the guidelines to be followed when handling member and
provider complaints and disputes
Answer: D
The following statements are about health plans' complaint resolution procedures (CRPs).
Three of the statements are true and one is false. Select the answer choice containing the
FALSE statement.
A. An health plan's CRPs reduce the likelihood of errors in decision making.
B. CRPs typically provide for at least two levels of appeal for formal appeals.
C. CRPs include only formal appeals and do not apply to informal complaints.
D. Most complaints are resolved without proceeding through the entire CRP process.
Answer: C
Health plans that offer complementary and alternative medicine (CAM) services face
potential liability because many types of CAM services
A. must be offered as separate supplemental benefits or separate products
B. lack clinical trials to evaluate their safety and effectiveness
C. are not covered by state or federal consumer protection statutes
D. focus on a specific illness, injury, or symptom rather than on the whole body
Answer: B
In order for a health plan’s performance-based quality improvement programs to be
effective, the desired outcomes must be
A. achievable within a specified timeframe
B. defined in terms of multiple results
C. expressed in subjective, qualitative terms
D. all of the above
Answer: A
The following statement(s) can correctly be made about performance measurement
1.The most difficult purpose for a performance measurement system to address is to
measure changes in outcomes caused by modifications in administrative or clinical
treatment processes
2.A health plan needs different performance measurement systems to evaluate its
administrative services and the clinical performance of its providers
A. Both 1 and 2
B. 1 only
C. 2 only
D. Neither 1 nor 2
Answer: C
Home healthcare encompasses a wide variety of medical, social, and support services
delivered at the homes of patients who are disabled, chronically ill, or terminally ill. The
time period(s) when health plans typically use home healthcare include
1.The period prior to a hospital admission
2.The period following discharge from a hospital
A. Both 1 and 2
B. 1 only
C. 2 only
D. Neither 1 nor 2
Answer: A
Designing effective medical management programs for Medicare beneficiaries requires an
understanding of the unique health needs of the Medicare population. One characteristic of
Medicare beneficiaries is that they typically
A. do not experience mental health problems
B. consume more than half of all prescription drugs
C. are likely to equate quality with the technical aspects of clinical procedures
D. require longer and more costly recovery periods following acute illnesses or injuries than
does the general population
Answer: D
The following statements are about disease management programs. Three of the
statements are true and one is false. Select the answer choice containing the FALSE
A. The focus of disease management is on responding to the needs of individual members
for extensive, customized healthcare supervision.
B. Disease management programs serve to improve both clinical and financial outcomes
for healthcare services related to chronic conditions.
C. Tools such as preventive care, self-care, and decision support programs are used to
support both case management and disease management.
D. Disease management programs apply to both diseases and medical conditions that are
not diseases, such as high-risk pregnancy, severe burns, and trauma.
Answer: A

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