Exambible AHM-540 Questions are updated and all AHM-540 answers are verified by experts. Once you have completely prepared with our AHM-540 exam prep kits you will be ready for the real AHM-540 exam without a problem. We have Updated AHIP AHM-540 dumps study guide. PASSED AHM-540 First attempt! Here What I Did.

AHIP AHM-540 Free Dumps Questions Online, Read and Test Now.

NEW QUESTION 1
The Medicaid population can be divided into subgroups based on their relative size and the costs of providing benefits. From the answer choices below, select the response that correctly identifies the subgroups that represent the largest percentages of the total Medicaid population and of total Medicaid expenditures. Largest % of Medicaid Population- Largest % of Medicaid Expenditures-

  • A. Largest % of Medicaid Population-dual eligibles Largest % of Medicaid Expenditures- children and low-income adults
  • B. Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for MedicareLargest % of Medicaid Expenditures-dual eligibles
  • C. Largest % of Medicaid Population-children and low-income adults Largest % of Medicaid Expenditures-chronically ill or disabled individuals not eligible for Medicare
  • D. Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for Medicare Largest % of Medicaid Expenditures-children and low-income adults

Answer: C

NEW QUESTION 2
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

Answer: D

NEW QUESTION 3
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.
The following statement(s) can correctly be made about Harbrace’s use of extra- contractual coverage:
* 1. Harbrace’s medical policy most likely establishes the procedure that Harbrace used to evaluate the value of Upzil for treating Ms. Ray
* 2. One way for Harbrace to reduce the risk associated with extra-contractual coverage is by including an alternative care provision in its contracts with purchasers

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

Answer: C

NEW QUESTION 4
In recent years, the demand for prescription drugs has increased dramatically. Factors that have contributed to this increase include

  • A. increased education regarding the purpose and benefits of drug formularies
  • B. reductions in the cost of prescription drugs
  • C. increased use of direct-to-consumer (DTC) advertising
  • D. all of the above

Answer: C

NEW QUESTION 5
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 6
When analyzing and applying HRA results, the Multistate Health Plan noted sampling bias. This information indicates that the HRA results

  • A. do not accurately depict the characteristics of the Multistate member population under study because of errors in data collection
  • B. are more accurate for individual Multistate members than they are for the total population
  • C. cannot be stated in numerical terms
  • D. indicate variation in the number, types, and severity of behavioral risks presented by Multistate’s members

Answer: A

NEW QUESTION 7
Most health plans require a PCP referral or precertification for CAM benefits.

  • A. True
  • B. False

Answer: B

NEW QUESTION 8
Elaine Newman suffered an acute asthma attack and was taken to a hospital emergency department for treatment. Because Ms. Newman’s condition had not improved enough following treatment to warrant immediate release, she was transferred to an observation care unit. Transferring Ms. Newman to the observation care unit most likely

  • A. resulted in unnecessarily expensive charges for treatment
  • B. prevented M
  • C. Newman from receiving immediate attention for her condition
  • D. gave M
  • E. Newman access to more effective and efficient treatment than she could have obtained from other providers in the same region
  • F. allowed clinical staff an opportunity to determine whether M
  • G. Newman required hospitalization without actually admitting her

Answer: D

NEW QUESTION 9
Determine whether the following statement is true or false:
The utilization review (UR) process produces the greatest number of case management referrals.

  • A. True
  • B. False

Answer: A

NEW QUESTION 10
One method that health plans use to address provider compliance with formularies is academic detailing.

  • A. True
  • B. False

Answer: A

NEW QUESTION 11
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 that you have chosen.
Under a delegation arrangement, the (delegate / delegator) is responsible for performing the delegated function according to established standards, and the (delegate / delegator) is ultimately accountable for any deficiencies in the performance of the function.

  • A. delegate / delegate
  • B. delegate / delegator
  • C. delegator / delegate
  • D. delegator / delegator

Answer: B

NEW QUESTION 12
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 two terms or phrases that you have selected.
The process for collecting and analyzing data differs for quality assessment (QA) and quality improvement (QI). For QA, data collection focuses on (objective / both objective and subjective) data, and data analysis identifies the (degree / cause) of variance.

  • A. objective / degree
  • B. objective / cause
  • C. both objective and subjective / degree
  • D. both objective and subjective / cause

Answer: A

NEW QUESTION 13
The following statement(s) can correctly be made about medical management considerations for the Federal Employee Health Benefits Program (FEHBP):
* 1. FEHBP plan members who have exhausted the health plan’s usual appeals process for a disputed decision can request an independent review by the Office of Personnel Management (OPM)
* 2. All health plans that cover federal employees are required to develop and implement patient safety initiatives

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

Answer: A

NEW QUESTION 14
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.
Greenhouse’s prescription drug reimbursement policy indicates that the plan formulary is classified as (open / closed), and that compliance by patients and providers is (mandatory / voluntary).

  • A. open / mandatory
  • B. open / voluntary
  • C. closed / mandatory
  • D. closed / voluntary

Answer: C

NEW QUESTION 15
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 16
The Brighton Health Plan regularly performs prospective UR for surgical procedures. Brighton’s prospective UR activities are likely to include

  • A. documenting the clinical details of the patient’s condition and care
  • B. tracking the length of inpatient stay
  • C. completing the discharge planning process
  • D. determining the most appropriate setting for the proposed course of care

Answer: D

NEW QUESTION 17
The Glenway Health Plan’s pharmacy and therapeutics (P&T) committee conducted pharmacoeconomic research to measure both the clinical outcomes and costs of two new cholesterol-reducing drugs. Results were presented as a ratio showing the cost required to produce a 1 mcg/l decrease in cholesterol levels. The type of pharmacoeconomic research that Glenway conducted in this situation was most likely

  • A. cost-effectiveness analysis (CEA)
  • B. cost-minimization analysis (CMA)
  • C. cost-utility analysis (CUA)
  • D. cost of illness analysis (COI)

Answer: A

NEW QUESTION 18
The following statements are about the characteristics of a utilization review (UR) program. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  • A. A primary goal of UR is to address practice variations through the application of uniform standards and guidelines.
  • B. UR evaluates whether the services recommended by a member’s provider are covered under the benefit plan.
  • C. UR recommends the procedures that providers should perform for plan members.
  • D. A health plan’s UR program is usually subject to review and approval by the state insurance and/or health departments.

Answer: C

NEW QUESTION 19
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

  • A. All of the above
  • B. 1 and 2 only
  • C. 1 and 3 only
  • D. 3 only

Answer: C

NEW QUESTION 20
Various government and independent agencies have created tools to measure and report the quality of healthcare. One performance measurement tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) is

  • A. the Health Plan Employer Data and Information Set (HEDIS®), which is a report card system for hospitals and long-term care facilities
  • B. HEDIS, which is a performance measurement tool that addresses both effectiveness of care and plan member satisfaction
  • C. the Consumer Assessment of Health Plans (CAHPS®), which was established to develop and implement a national strategy for quality measurement and reporting
  • D. CAHPS, which is a tool that measures consumer satisfaction with specific aspects of health plan services

Answer: D

NEW QUESTION 21
......

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