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Exam Code: AHM-540Exam Name: Medical Management
One year free update, No help, Full refund!
AHM-540 Study Guide Total Q&A: 163 Questions and Answers
Last Update: 2015-07-30
AHM-540 Exam Cram Detail : AHM-540 Study Guide
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NO.1 The paragraph below contains an incomplete statement. Select the answer choice containing
the term that correctly completes the paragraph.
Medical management programs often require the analysis of many types of data and information.
__________________ is an automated process that analyzes variables to help detect patterns and
relationships in the data.
A. Unbundling
B. Outsourcing
C. Data mining
D. Drilling down
Answer: C
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NO.2 Health plans communicate proposed performance changes through action statements. Select
the answer choice containing an action statement that includes all of the required elements.
A. The proportion of adult members who are screened for hypertension will increase by ten percent.
B. Primary care providers (PCPs) will increase the proportion of children under the age of two who
are up-to-date on immunizations by seven percent within one year.
C. The QM program director will evaluate the level of provider compliance with clinical practice
guidelines (CPGs).
D. The disease management program director will increase participation by asthmatic children in the
health plan's pediatric asthma disease management program.
Answer: B
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NO.3 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
A. provides health and disability benefits to employees injured on the job only if the employer is at
fault for the injury
B. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs
C. manages costs by including employee cost-sharing features in its benefit design
D. places limits on benefits by restricting the amount of benefit payments or the number of covered
hospital days or provider office visits
Answer: B
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NO.4 For this question, if answer choices (A) through (C) are all correct, select answer choice (D).
Otherwise, select the one correct answer choice.
The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and
Medicare Services (CMS) initiative designed to strengthen health plans' efforts to protect and
improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards
apply to
A. standard medical-surgical services
B. mental health and substance abuse services
C. services offered to Medicare enrollees as optional supplementary benefits
D. all of the above
Answer: D
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NO.5 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.
Answer: D
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NO.6 The following statements describe situations in which health plan members have medical
problems that require care. Select the statement that describes a situation in which self-care most
likely would not be appropriate.
A. Two days after bruising her leg, Avis Bennet notices that the pain from the bruise has increased
and that there are red streaks and swelling around the bruised area.
B. Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several times each
day.
C. Caroline Evans has severe arthritis that requires regular exercise and oral medication to reduce
pain and help her maintain mobility.
D. Oscar Gracken is recovering from a heart attack and requires ongoing cardiac rehabilitation.
Answer: A
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NO.7 In most health plans, the formulary system is developed and managed by a P&T committee. The
P&T committee is responsible for
A. evaluating and selecting drugs for inclusion in the formulary
B. overseeing the manufacture, distribution, and marketing of prescription drugs
C. certifying the medical necessity of expensive, potentially toxic, or nonformulary drugs
D. all of the above
Answer: A
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NO.8 Since its inception, Medicare has undergone a number of changes because of legal and
regulatory action. One result of the Balanced Budget Act (BBA) of 1997 has been to
A. expand Medicare benefits by mandating coverage for certain preventive services
B. reduce the number of organizations that can deliver covered services
C. encourage growth of managed Medicare programs in all markets
D. increase the number of "zero premium" plans available to Medicare beneficiaries
Answer: A
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