AHM-540 AHIP Exam Questions and Free Practice Test

Question 31

Health plans that offer complementary and alternative medicine (CAM) services face potential liability because many types of CAM services

A. must be offered as separate supplemental benefits or separate products

B. lack clinical trials to evaluate their safety and effectiveness

C. are not covered by state or federal consumer protection statutes

D. focus on a specific illness, injury, or symptom rather than on the whole body

Correct Answer:B

Question 32

Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.
For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.
Decisions regarding Mr. Farrell’s end-of-life care are legally the right and responsibility of

A. M

B. Farrell and his family

C. M

D. Farrell’s physician

E. M

F. Farrell’s health plan

G. All of the above

Correct Answer:A

Question 33

A health plan’s choice of structure measures, process measures, and outcome measures to evaluate performance depends in part on the scientific soundness of the measures. One approach that a health plan can use to enhance scientific soundness is stratification, which refers to the

A. identification and removal of unusual cases, such as patients with contraindications to a particular treatment, from consideration

B. statistical adjustment of outcome measures to account for differences in the severity of illness or the presence of other medical conditions

C. specification of a target population for a procedure and the data collection and analysis methods to be used

D. elimination of variation within a patient population by dividing the population into groups that are at a similar level of risk

Correct Answer:D

Question 34

Health plans that choose to contract with external organizations for pharmacy services typically contract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for a health plan include
* 1.Managing the costs of prescription drugs
* 2.Promoting efficient and safe drug use
* 3.Determining the health plan’s internal management responsibilities for pharmacy services

A. All of the above

B. 1 and 2 only

C. 2 and 3 only

D. 1 only

Correct Answer:B

Question 35

The following statements are about risk management for case management. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

A. The use of a signed consent authorization form is consistent with accrediting agency standards for patient privacy and confidentiality of medical information.

B. Case management that is initiated after a member has incurred substantial medical expenses is more likely to be viewed as a tool to cut costs rather than to improve outcomes.

C. Health plan documents indicating that any case management delegates are separate, independent entities may reduce an health plan's exposure to risk.

D. A case management file cannot be used to support the health plan's position in the event of a lawsuit.

Correct Answer:D

Question 36

The following statement(s) can correctly be made about utilization guidelines:
* 1. When developing utilization guidelines, health plans balance evidence-based criteria with experience-based criteria
* 2. Utilization guidelines indicate when a UR nurse should refer a decision to a physician reviewer

A. Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

Correct Answer:A

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