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AHM-540 Online Practice Questions and Answers

Questions 4

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.

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Questions 5

Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say

A. that they are focused primarily on health maintenance organization (HMO) plans

B. that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS)

3.0

C. that they are used to rank the performance of various health plans

D. all of the above

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Questions 6

Determine whether the following statement is true or false:

Immunization programs are a direct means of reducing health plan members' needs for healthcare services and are typically cost-effective.

A. True

B. False

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Questions 7

The Carlyle Health Plan uses the following clinical outcome measures to evaluate its diabetes and asthma disease management programs:

Measure 1: The percentage of diabetic patients who receive foot exams from their providers according to the program's recommended guidelines Measure 2: The number of asthma patients who visited emergency departments for acute asthma attacks

From the answer choices below, select the response that correctly identifies whether these measures are true outcome measures or intermediate outcome measures. Measure 1- Measure 2

A. Measure 1-true outcome measure Measure 2-true outcome measure

B. Measure 1-true outcome measure Measure 2-intermediate outcome measure

C. Measure 1-intermediate outcome measure Measure 2-true outcome measure

D. Measure 1-intermediate outcome measure Measure 2-intermediate outcome measure

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Questions 8

The paragraph below contains two pairs of terms or phrases enclosed in parentheses. Determine which term or phrase in each pair correctly completes the paragraph. Then select the answer choice containing the terms or phrases that you have chosen.

The Millway Health Plan received a 15% reduction in the price of a particular pharmaceutical based on the volume of the drug Millway purchased from the manufacturer. This reduction in price is an example of a (rebate / price discount) and (is / is not) dependent on actual provider prescribing patterns.

A. rebate / is

B. rebate / is not

C. price discount / is

D. price discount / is not

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Questions 9

The Noble Health Plan conducted a cost/benefit analysis of the following four prescription drugs: BenefitCost

Drug A$525$350

Drug B$450$250 Drug C$400$200 Drug D$350$100 According to this analysis, the drug that represents the most efficient use of resources is

A. Drug A

B. Drug B

C. Drug C

D. Drug D

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Questions 10

When conducting performance assessment, a health pln may classify the key processes associated with its services into the following categories: high-risk, high-volume, problem- prone, and high-cost.

The following statements are about this classification of processes. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

A. In some instances, relatively inexpensive processes can qualify as high-cost processes.

B. Each process must be classified into a single category.

C. High-risk processes most often involve medical interventions or treatment plans for acute illnesses or case management processes for complex conditions.

D. Administrative processes such as scheduling appointments are examples of high- volume processes.

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Questions 11

Breanna Osborn is a case manager for a regional health plan. One component of Ms. Osborn's job is the collection and evaluation of medical, financial, social, and psychosocial information about a member's situation. This component of Ms. Osborn's job is known as

A. case identification

B. case management planning

C. healthcare coordination

D. case assessment

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Questions 12

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

A. Health plans rarely delegate HRA activities to external entities

B. Health plans typically focus their HRA efforts on newly enrolled members

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

D. HRA is generally a reliable predictor of medical resource utilization

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Questions 13

Administrative action plans are used when performance problems or opportunities are related to the way the organization itself operates. The following statement(s) can correctly be made about administrative action plans:

1.Administrative action plans allow health plans to coordinate management activities 2.One function of administrative action plans is to integrate service across all levels of the organization

3.Administrative action plans are designed to improve outcomes by helping plan members assume responsibility for their own health

A. All of the above

B. 1 and 2 only

C. 1 and 3 only

D. 2 and 3 only

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Exam Code: AHM-540
Exam Name: Medical Management
Last Update: Mar 21, 2024
Questions: 163
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