AHIP Medical Management - AHM-540 模擬練習
Determine whether the following statement is true or false: Participation in disease management programs is currently voluntary.
正解: A
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.
The document that Mr. Farrell is using to communicate his end-of-life healthcare wishes to his family is known as a
The document that Mr. Farrell is using to communicate his end-of-life healthcare wishes to his family is known as a
正解: A
In recent years, the demand for prescription drugs has increased dramatically. Factors that have contributed to this increase include
正解: A
For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.
Ways that workers' compensation health plans can help control the costs of job-related injuries and illnesses include
Ways that workers' compensation health plans can help control the costs of job-related injuries and illnesses include
正解: D
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
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
正解: A
Economically, health plans cannot provide coverage for every drug available from every
manufacturer. As a result, purchaser contracts often include provisions specifying that certain drugs or drug types will not be covered. These provisions are referred to as
manufacturer. As a result, purchaser contracts often include provisions specifying that certain drugs or drug types will not be covered. These provisions are referred to as
正解: D
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.
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.
正解: B
Health plan performance measures include structure measures, process measures, and outcome measures. The following statements are about the characteristics of these three types ofperformance measures. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
正解: B
Skilled nursing facilities (SNFs) are required by law to have formal programs for quality improvement and to monitor these programs using established standards. These requirements are described in
1.The Omnibus Budget Reconciliation Act (OBRA) of 1986
2.The Balanced Budget Act (BBA) of 1997
1.The Omnibus Budget Reconciliation Act (OBRA) of 1986
2.The Balanced Budget Act (BBA) of 1997
正解: D
Health plans often use accreditation as a means of evaluating the quality of care delivered to plan members. Accreditation of subacute care providers is available from the
正解: C
By definition, the development and implementation of parameters for the delivery of healthcare services to a health plan's members is known as
正解: D
The following statement(s) can correctly be made about the characteristics of peer review: 1.Peer review is applicable to either single episodes of care or to entire programs of care 2.Most peer review is conducted concurrently
3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
正解: A
The following statement(s) can correctly be made about the use of screening for secondary prevention:
1.Screening activities may involve specialty care providers as well as primary care providers (PCPs) and the health plan
2.Secondary prevention often results in more utilization of services immediately following screening
3.Screening focuses on members who have not experienced any symptoms of a particular illness
1.Screening activities may involve specialty care providers as well as primary care providers (PCPs) and the health plan
2.Secondary prevention often results in more utilization of services immediately following screening
3.Screening focuses on members who have not experienced any symptoms of a particular illness
正解: C
Determine whether the following statement is true or false:
The utilization review (UR) process produces the greatest number of case management referrals.
The utilization review (UR) process produces the greatest number of case management referrals.
正解: A