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  • Exam Name: Medical Management
  • Last Update: 18-Apr-2024
  • Questions and Answers: 163
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AHM-540 Questions and Answers

Question # 1

Many health plans use HRA to target their preventive care programs to the healthcare needs of their members. With regard to HRA, it is correct to say that

A.

Health plans rarely delegate HRA activities to external entities

B.

Health plans typically focus their HRA efforts on newly enrolled members

C.

HRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members

D.

HRA is generally a reliable predictor of medical resource utilization

Question # 2

The following statements are about the use of hospitalists to manage inpatient care. Select the answer choice containing the correct statement.

A.

A patient who has been transferred to a hospitalist for management of inpatient care usually continues to receive care from the hospitalist after discharge.

B.

Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.

C.

In order to serve as a hospitalist, a physician must have a background in critical care medicine.

D.

Hospitalists typically spend at least one-quarter of their time in a hospital setting.

Question # 3

Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQA. These NCQA credentialing standards apply to

A.

chiropractors

B.

naturopaths

C.

acupuncturists

D.

all of the above

Question # 4

The American Accreditation HealthCare Commission/URAC (URAC) has an accreditation program specifically for case management services. From the answer choices below, select the response that correctly identifies the type(s) of case management services addressed by URAC’s standards and the type(s) of organizations to which these standards may be applied.

A.

Type(s) of Services-on-site services only Type(s) of Organization-health plans only

B.

Type(s) of Services-on-site services only Type(s) of Organization-any organization that performs case management functions

C.

Type(s) of Services-both telephonic and on-site services Type(s) of Organization-health plans only

D.

Type(s) of Services-both telephonic and on-site services Type(s) of Organization-any organization that performs case management functions

Question # 5

State governments serve as both regulators and purchasers of health plan services. The influence of state governments as purchasers is focused on

A.

Medicare and TRICARE programs

B.

Medicaid and workers’ compensation programs

C.

Medicare and Medicaid programs

D.

TRICARE and workers’ compensation programs

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