Proper study guides for Renewal AHIP Medical Management certified begins with AHIP AHM-540 preparation products which designed to deliver the Accurate AHM-540 questions by making you pass the AHM-540 test at your first time. Try the free AHM-540 demo right now.

Free demo questions for AHIP AHM-540 Exam Dumps Below:

NEW QUESTION 1
The following statements are about health plans’ development of medical policies. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  • A. Technology assessment is applicable only to medical policy development for new medical procedures, devices, drugs, and tests.
  • B. Technology assessment provides the scientific rationale for the medical policy section that specifies when a medical service is appropriate and when it is not.
  • C. The medical policy development process includes both a clinical and an operational review of a proposed medical policy.
  • D. The decision to accept or reject a proposed medical policy often depends on how a new technology compares to currently used interventions.

Answer: A

NEW QUESTION 2
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

  • A. Both 1 and 2
  • B. 1 only
  • C. 2 only
  • D. Neither 1 or 2

Answer: B

NEW QUESTION 3
This agency has authority over Programs of All-inclusive Care for the Elderly (PACE) and the State Children’s Health Insurance Program (SCHIP).

  • 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)

Answer: C

NEW QUESTION 4
The paragraph below contains two pairs of terms enclosed in parentheses. Select the term in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms you have chosen.
A primary distinction between skilled care and subacute care relates to the extent and medical complexity of the patient’s needs. Generally, subacute care patients require (more
/ fewer) services from physicians and nurses and (more / less) extensive rehabilitation services than do skilled care patients.

  • A. more / more
  • B. more / less
  • C. fewer / more
  • D. fewer / less

Answer: A

NEW QUESTION 5
The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to

  • A. remove behavioral healthcare services from the primary care setting
  • B. shift behavioral healthcare from acute inpatient settings to alternative settings when feasible
  • C. reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient
  • D. offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members

Answer: B

NEW QUESTION 6
Most health plans require a PCP referral or precertification for CAM benefits.

  • A. True
  • B. False

Answer: B

NEW QUESTION 7
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

  • A. providing a framework for care while also allowing for patient-specific variations, based on physician judgment
  • B. serving as a basis for evaluating whether providers are practicing in accordance with accepted standards
  • C. focusing on the prevention or early detection of a particular condition
  • D. all of the above

Answer: D

NEW QUESTION 8
Emilio Martinez, a member of the Bloom Health Plan, has recently been diagnosed with prostate cancer by his physician, Dr. Robert Cohen. Mr. Martinez has decided to participate in Bloom’s shared decision-making program for prostate cancer. On the basis of this information, it is most likely correct to say
* 1. That verification of Mr. Martinez’s understanding about his care options protects both Dr. Cohen and Bloom against charges of malpractice
* 2. That Mr. Martinez and Dr. Cohen will discuss the care options available to Mr. Martinez, but the ultimate decision about care is up to Dr. Cohen

  • A. Both 1 and 2
  • B. 1 only
  • C. 2 only
  • D. Neither 1 nor 2

Answer: D

NEW QUESTION 9
Vision care is typically separated into two categories: routine eye care and clinical eye care. The standard benefit plans offered by most health plans include coverage for
* 1. Routine eye care
* 2. Clinical eye care

  • A. Both 1 and 2
  • B. 1 only
  • C. 2 only
  • D. Neither 1 nor 2

Answer: C

NEW QUESTION 10
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 investigational
  • 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

NEW QUESTION 11
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.

  • A. yes/no
  • B. sentinel event
  • C. discrete variable
  • D. continuous variable

Answer: D

NEW QUESTION 12
Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the

  • A. lack of qualified providers in provider networks
  • B. lack of resources necessary to establish case management programs for patients with complex conditions
  • C. unstable eligibility status of Medicaid recipients
  • D. inability of Medicaid recipients to change health plans or PCPs

Answer: C

NEW QUESTION 13
One of the steps in drug utilization review (DUR) is defining optimal drug use, which can be accomplished by applying diagnosis criteria and drug-specific criteria. Drug-specific criteria are standards that identify the

  • A. appropriate dosages, duration of treatment, and other elements related to the use of a particular drug
  • B. actual prescribing and dispensing patterns for a particular drug
  • C. types of diseases, conditions, or patients for which a drug should be used
  • D. cost-effectiveness of all possible drug treatments for a particular condition

Answer: A

NEW QUESTION 14
The Harbor Health Plan’s formulary policy encourages network pharmacists who are asked to fill a prescription for a costly, brand-name drug to dispense a different chemical entity within the same drug class in order to reduce costs. This type of drug substitution is referred to as

  • A. generic substitution, and prescriber approval is not required
  • B. generic substitution, and prescriber approval is always required
  • C. therapeutic substitution, and prescriber approval is not required
  • D. therapeutic substitution, and prescriber approval is always required

Answer: D

NEW QUESTION 15
Many health plans use clinical pathways to help manage the delivery of acute care services to plan members. One true statement about clinical pathways is that they

  • A. determine which healthcare services are medically necessary and appropriate for a particular patient in a particular situation
  • B. outline the services that will be delivered, the providers responsible for delivering the services, the timing of delivery, the setting in which services are delivered, and the expected outcomes of the interventions
  • C. cover only services delivered in an acute inpatient setting
  • D. address medical conditions that affect a small segment of a given population and with which the majority of providers are unfamiliar

Answer: B

NEW QUESTION 16
The Quality Assessment Performance Improvement (QAPI) is a quality initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare and Medicaid health plan enrollees. The Centers for Medicare and Medicaid Services (CMS) requires compliance with QAPI from

  • A. both Medicare+Choice plans and Medicaid health plans
  • B. Medicare+Choice plans only
  • C. Medicaid health plans only
  • D. neither Medicare+Choice plans nor Medicaid health plans

Answer: B

NEW QUESTION 17
......

P.S. Easily pass AHM-540 Exam with 163 Q&As Certleader Dumps & pdf Version, Welcome to Download the Newest Certleader AHM-540 Dumps: https://www.certleader.com/AHM-540-dumps.html (163 New Questions)