Download AHM Medical Management Exam.AHM-540.PassLeader.2019-03-08.36q.vcex

Vendor: AHIP
Exam Code: AHM-540
Exam Name: AHM Medical Management Exam
Date: Mar 08, 2019
File Size: 26 KB
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Demo Questions

Question 1
Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute. 
If Ms. Stanley agrees to the generic substitution, she will receive a drug that
  1. has not been tested for safety and efficacy in large clinical trials
  2. is available without a prescription at a reasonable cost
  3. has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective
  4. contains active ingredients that are identical to those of the prescribed brand-name drug
Correct answer: D
Question 2
A health plans coverage policies are linked to its purchaser contracts. The following 
statement(s) can correctly be made about the purchaser contract and coverage decisions:
  1. In case of conflict between the purchaser contract and a health plans medical policy or benefits administration policy, the contract takes precedence 
  2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 
  3. All of the criteria for coverage decisions must be included in the purchaser contract
  1. All of the above
  2. 1 and 2 only
  3. 2 only
  4. 3 only
Correct answer: B
Question 3
Most health plans require a PCP referral or precertification for CAM benefits.
  1. True
  2. False
  3. True and False
  4. No one
Correct answer: B
Question 4
Private employers are key purchasers of health plan services. The following statement(s) 
can correctly be made about employer expectations about the quality and cost-effectiveness of healthcare services:
  1. For both health maintenance organizations (HMOs) and non-HMO plans, employers typically have access to accreditation results and performance measurement reports to help them evaluate the quality of healthcare and service 
  2. Because of employers concern about the quality and costs of healthcare services available through health plans, direct contracting has become a dominant model among employers who sponsor health benefit programs for their employees
  1. Both 1 and 2
  2. 1 only
  3. 2 only
  4. Neither 1 nor 2
Correct answer: D
Question 5
Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute. 
The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen. 
Greenhouses prescription drug reimbursement policy indicates that the plan formulary is classified as (open / closed), and that compliance by patients and providers is (mandatory / voluntary).
  1. open / mandatory
  2. open / voluntary
  3. closed / mandatory
  4. closed / voluntary
Correct answer: C
Question 6
Selene Varga is participating in her health plans disease management program for congestive heart failure. Ms. Vargas 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. Vargas overall care plan. This information indicates that Ms. 
Varga is participating in the type of disease management program known as a
  1. coordinated outreach model program
  2. case management model program
  3. hub-and-spoke model program
  4. group clinic model program
Correct answer: B
Question 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.
  1. True
  2. False
  3. True and False
  4. No one
Correct answer: A
Question 8
Health plans that offer complementary and alternative medicine (CAM) services face potential liability because many types of CAM services
  1. must be offered as separate supplemental benefits or separate products
  2. lack clinical trials to evaluate their safety and effectiveness
  3. are not covered by state or federal consumer protection statutes
  4. focus on a specific illness, injury, or symptom rather than on the whole body
Correct answer: B
Question 9
Among this agencys accreditation programs are accreditation for preferred provider organizations (PPOs), health plan call centers, and case management organizations. This agency classifies its standards as either shall standards or should standards.
  1. American Accreditation HealthCare Commission/URAC (URAC)
  2. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  3. Community Health Accreditation Program (CHAP)
  4. National Committee for Quality Assurance (NCQA)
Correct answer: A
Question 10
Nilay Sharma suffered a small wound while working in his yard and was taken to a local hospital for treatment. A triage nurse at the hospital evaluated Mr. Sharmas condition and directed him to an outpatient unit in the hospital where a physician assistant examined, cleaned, and sutured the wound. Mr. Sharma returned home following treatment. The care Mr. Sharma received at the hospital is an example of the type of care known as
  1. specialty referral
  2. primary prevention
  3. urgent care
  4. emergency care
Correct answer: C
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