AHM-540 AHIP Exam Questions and Free Practice Test

Question 25

Performance variance can be classified as either common cause variance or special cause variance. The following statement(s) can correctly be made about special cause variance:
* 1. Inadequate staffing levels, employee errors, and equipment malfunctions are examples of special cause variance
* 2. Special cause variance is typically more difficult to detect and correct than is common cause variance

A. Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

Correct Answer:B

Question 26

Maxwell Midler’s health plan operates a drug formulary that includes a typical three-tier copayment structure with required copayments of $5, $10, and $25. Mr. Midler recently filled a prescription for a $75 drug that was not included in the formulary. According to the plan’s formulary copayment structure, the amount that Mr. Midler was required to pay for his prescription was

A. $5

B. $10

C. $25

D. $75

Correct Answer:C

Question 27

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

Correct Answer:C

Question 28

All states have laws describing the conditions under which pharmacists can substitute a generic drug for a brand-name drug. With respect to these laws, it is correct to say that in every state,

A. pharmacists must obtain physician approval before substituting generics for brand-name drugs

B. pharmacists must obtain authorization from the health plan before substituting generics for brand-name drugs

C. prescribers must obtain authorization from the health plan before prescribing a brand- name drug

D. prescribers have some mechanism that allows them to prevent pharmacists from substituting generics for brand-name drugs

Correct Answer:D

Question 29

One difference between outcomes research and clinical research is that outcomes research

A. provides an absolute measure of treatment results, whereas clinical research provides a relative measure of results

B. focuses on treatment effectiveness, whereas clinical research focuses on treatmentefficacy

C. examines diseases and treatments in isolation, whereas clinical research considers the effects of changes in health status and quality of life

D. gathers outcomes data from controlled clinical trials, whereas clinical research collects and analyzes clinical, financial, and administrative data

Correct Answer:B

Question 30

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.

Correct Answer:B

START AHM-540 EXAM