AHM-540 AHIP Exam Questions and Free Practice Test

Question 13

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

Correct Answer:C

Question 14

To improve members’ abilities to make appropriate care decisions about specific medical problems, some health plans use a form of decision support known as telephone triage programs. The following statements are about telephone triage programs. Select the answer choice containing the correct statement.

A. The primary role of telephone triage clinical staff is to diagnose the caller’s condition and give medical advice.

B. Quality management (QM) for telephone triage programs typically focuses on the clinical information provided rather than on the quality of service.

C. Currently, none of the major accrediting agencies offers an accreditation program specifically for telephone triage programs.

D. A telephone triage program may also include a self-care component.

Correct Answer:B

Question 15

The American Accreditation HealthCare Commission/URAC (URAC) has an accreditation program specifically for case management services. From the answer choices below, select the response that correctly identifies the type(s) of case management services addressed by URAC’s standards and the type(s) of organizations to which these standards may be applied.

A. Type(s) of Services-on-site services only Type(s) of Organization-health plans only

B. Type(s) of Services-on-site services only Type(s) of Organization-any organization that performs case management functions

C. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-health plans only

D. Type(s) of Services-both telephonic and on-site services Type(s) of Organization-any organization that performs case management functions

Correct Answer:D

Question 16

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

Correct Answer:A

Question 17

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.
One component of UR is an administrative review. An administrative review compares the proposed medical care to the applicable (medical policy / contract provision). This type of review (can / cannot) be conducted by a nonclinical staff member.

A. medical policy / can

B. medical policy / cannot

C. contract provision / can

D. contract provision / cannot

Correct Answer:C

Question 18

Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated care plans (CCPs). Unlike other coverage options, CCPs

A. provide only those benefits covered by Medicare Part A and Part B

B. are not subject to federal or state regulation

C. place primary care at the center of the delivery system

D. are structured as indemnity plans

Correct Answer:C

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