AHM-540 AHIP Medical Management exact Exam Questions

Medical Management

Last Update 11 hours ago Total Questions : 163

The Medical Management content is now fully updated, with all current exam questions added 11 hours ago. Deciding to include AHM-540 practice exam questions in your study plan goes far beyond basic test preparation.

You'll find that our AHM-540 exam questions frequently feature detailed scenarios and practical problem-solving exercises that directly mirror industry challenges. Engaging with these AHM-540 sample sets allows you to effectively manage your time and pace yourself, giving you the ability to finish any Medical Management practice test comfortably within the allotted time.

Question # 21

Determine whether the following statement is true or false:

Independent review organizations (IROs) can mediate disputes and offer advisory opinions to health plans on UR issues, but they cannot render binding decisions on appeals.

True

False

Question # 22

PBMs are accredited by the same organizations that accredit health plans.

True

False

Question # 23

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

increased education regarding the purpose and benefits of drug formularies

reductions in the cost of prescription drugs

increased use of direct-to-consumer (DTC) advertising

all of the above

Question # 24

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

Many health plans use data warehouses to assist with the performance of medical management activities. With respect to the characteristics of data warehouses, it is generally correct to say

that the construction of a data warehouse is quick and simple

that a data warehouse addresses the problems associated with multiple data management systems

that a data warehouse stores only current data

all of the above

Question # 25

The delivery of quality, cost-effective healthcare is a primary goal of both group healthcare and workers’ compensation programs. One difference between group healthcare and workers’ compensation is that workers’ compensation

provides health and disability benefits to employees injured on the job only if the employer is at fault for the injury

provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs

manages costs by including employee cost-sharing features in its benefit design

places limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits

Question # 26

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.

If Ms. Stanley agrees to the generic substitution, she will receive a drug that

has not been tested for safety and efficacy in large clinical trials

is available without a prescription at a reasonable cost

has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective

contains active ingredients that are identical to those of the prescribed brand-name drug

Question # 27

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

must pay the entire cost of the examination

must obtain a referral to a dentist from her primary care provider (PCP)

can schedule the examination without preauthorization of payment by the DHMO

can schedule an unlimited number of examinations and cleanings per year

Question # 28

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

cost-effectiveness analysis (CEA)

cost-minimization analysis (CMA)

cost-utility analysis (CUA)

cost of illness analysis (COI)

Question # 29

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.

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

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

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

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

Question # 30

One method of transferring the information in electronic medical records (EMRs) is through a health information network (HIN). The following statements are about HINs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

A HIN may afford a health plan better measurements of outcomes and provider performance.

The use of a HIN typically increases a health plan’s exposure to liability for poor care.

Most HINs are Internet-based rather than built on proprietary computer networks.

Currently, the majority of health plans do not have HINs that are capable of transferring medical records among their network providers.