05 January, 2025

The Updated Guide To AHM-540 Actual Test

we provide Vivid AHIP AHM-540 real exam which are the best for clearing AHM-540 test, and to get certified by AHIP Medical Management. The AHM-540 Questions & Answers covers all the knowledge points of the real AHM-540 exam. Crack your AHIP AHM-540 Exam with latest dumps, guaranteed!

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Total 163 questions Full Exam Access

Question 1

Health plans that offer complementary and alternative medicine (CAM) services face potential liability because many types of CAM services

must be offered as separate supplemental benefits or separate products

lack clinical trials to evaluate their safety and effectiveness

are not covered by state or federal consumer protection statutes

focus on a specific illness, injury, or symptom rather than on the whole body

Question 2

Health plans conduct evaluations on the efficiency and effectiveness of their quality improvement activities. With regard to the effectiveness of quality improvement plans, it is correct to say that

effectiveness is the relationship between what the organization puts into an improvement plan and what it gets out of the plan

effectiveness is measured by reviewing outcomes to determine the accuracy or appropriateness of the strategy and the adequacy of resources allocated to that strategy

the effectiveness of an action plan is typically measured with a concurrent evaluation

an evaluation of plan effectiveness produces one of two results: the plan either (a) achieved the desired outcomes or (b) did not achieve the desired outcomes and is unlikely to do so under current conditions

Question 3

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

Health plans rarely delegate HRA activities to external entities

Health plans typically focus their HRA efforts on newly enrolled members

HRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members

HRA is generally a reliable predictor of medical resource utilization

Question 4

Patient safety and medical errors are important concerns for both quality management (QM) and risk management. The following statement(s) can correctly be made about medical errors:
* 1. The complexity of modern medicine and healthcare delivery systems increases patients’ exposure to the risks of medical errors
* 2. Licensing boards for healthcare professionals in all states provide a consistent system of quality oversight and accountability
* 3. Provider compliance with internal incident reporting requirements is low

All of the above

1 and 2 only

1 and 3 only

3 only

Question 5

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.

yes/no

sentinel event

discrete variable

continuous variable

Question 6

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.

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.

Question 7

Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treat Ms. Ray’s condition, her physician has prescribed Upzil, a medication that has Food and Drug Administration (FDA) approval only for the treatment of depression. Upzil has not been tested for safety or effectiveness in the treatment of migraine headache. Although Harbrace’s medical policy for migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extra-contractual coverage of Upzil for Ms. Ray.
In this situation, the prescribing of Upzil for Ms. Ray’s headaches is an example of

a cosmetic service

an investigational service

an off-label use

a quality-of-life service

Question 8

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

applying strict definitions of medical necessity

developing prevention and recovery programs

applying out-of-network benefit reductions

all of the above

Question 9

MCOs usually have a formal program for the oversight of delegated activities. The following statements concern typical delegation oversight programs. Select the answer choice containing the correct statement.

A letter of intent is the contractual document that describes the delegated functions and the responsibilities of the MCO and the delegate.

In most cases, the evaluation of a candidate for delegation is based entirely on the candidate’s application and supporting documentation and does not include an on-site assessment of the candidate.

Under most delegation agreements, an MCO cannot terminate the agreement before the end date stated in the agreement.

One objective for a delegation oversight program is to integrate any delegated activities into the MCO’s overall programs for medical management and other functions.

Question 10

For this question, if answer choices (a) through (c) are all correct, select answer choice (d). Otherwise, select the one correct answer choice.
Well-crafted clinical practice guidelines (CPGs) can benefit healthcare delivery processes and outcomes by

providing a framework for care while also allowing for patient-specific variations, based on physician judgment

serving as a basis for evaluating whether providers are practicing in accordance with accepted standards

focusing on the prevention or early detection of a particular condition

all of the above

Question 11

Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.
For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.
Decisions regarding Mr. Farrell’s end-of-life care are legally the right and responsibility of

Farrell and his family

Farrell’s physician

Farrell’s health plan

All of the above

Question 12

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

do not experience mental health problems

consume more than half of all prescription drugs

are likely to equate quality with the technical aspects of clinical procedures

require longer and more costly recovery periods following acute illnesses or injuries than does the general population

Question 13

Skilled nursing facilities (SNFs) are required by law to have formal programs for quality improvement and to monitor these programs using established standards. These requirements are described in
* 1.The Omnibus Budget Reconciliation Act (OBRA) of 1986
* 2.The Balanced Budget Act (BBA) of 1997

Both 1 and 2

1 only

2 only

Neither 1 or 2

Question 14

The Fairview Health Plan uses a dual database approach to integrate information needed for its disease management program. This information indicates that Fairview uses an information management system that

combines all existing information from all data sources into a single comprehensive system

connects multiple databases with a central interface engine that acts as an information clearinghouse

provides an outside vendor with pertinent data that the vendor compiles into an integrated database

creates a separate database that pulls pertinent information from the health plan’s claims database, formats the information for easy analysis, and stores it in the separate database

Question 15

The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.
The Balanced Budget Act (BBA) of 1997 established the use of _______ to determine coverage of emergency services for Medicare and Medicaid enrollees in health plans.

utilization management standards

the prudent layperson standard

preauthorization

diagnosis-based retrospective review

Question 16

Step-therapy is a form of prior authorization that reserves the use of more expensive medications for cases in which the use of less expensive medications has been unsuccessful. Step-therapy is appropriate for situations in which
* 1.A significant percentage of those treated with the initial therapy will require the second therapy
* 2.The delay created when a patient moves from one therapy to the next therapy will not cause serious or permanent effects

Both 1 and 2

1 only

2 only

Neither 1 nor 2

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Total 163 questions Full Exam Access