AHM-540 Online Practice Questions and Answers

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

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

TRICARE enrollees have the right to challenge authorization and coverage decisions. Such challenges are referred to as (appeals / grievances) and are typically handled by the (TRICARE contractor / Area Field Office).

A. appeals / TRICARE contractor

B. appeals / Area Field Office

C. grievances / TRICARE contractor

D. grievances / Area Field Office

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

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

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

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

D. 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

To facilitate electronic commerce (eCommerce), a health plan may establish a secured extranet. One true statement about a secured extranet is that it is

A. based on Web-based technologies

B. available only to the employees of the health plan

C. publicly available, so the potential exists for unauthorized access to a health plan's proprietary systems

D. used to handle the majority of health plan eCommerce

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

The following statement(s) can correctly be made about the hospitalist approach to inpatient care management:

1.Management of inpatient care by hospitalists may significantly reduce the length of stay and the total costs of care for a hospital admission

2.Most health plans that use hospitalists do so through a voluntary hospitalist program

3.A

hospitalist's familiarity with utilization management (UM) and quality management (QM) standards for inpatient care may reduce unnecessary variations in care and improve clinical outcomes

A.

All of the above

B.

1 and 2 only

C.

1 and 3 only

D.

2 only

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans' efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

A. standard medical-surgical services

B. mental health and substance abuse services

C. services offered to Medicare enrollees as optional supplementary benefits

D. all of the above

The Strathmore Health Plan uses clinical pathways to manage its acute care services. In order to reduce the risk of financial liability associated with the use of clinical pathways, Strathmore and its network hospitals should

A. base pathways on relevant evidence reported in medical literature

B. restrict each pathway to a single medical condition

C. use pathways to establish a new standard of care

D. allow providers to use only those interventions listed in the pathways

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

To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data:

1.Patient surveys are the most widely used source of disease-specific clinical information

2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers

3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status

A. All of the above

B. 1 and 2 only

C. 2 and 3 only

D. 3 only