AHM-540 Free Practice Test

One way that health plans can make their benefits more appealing to employers and
employees is to offer coverage for specialty services. It is correct to say that specialty services typically

1. A. involve the same types of providers and delivery systems as do standard medical services
2. B. are a subset of a health plan’s standard medical-surgical services
3. C. are not monitored by health plans for quality or utilization
4. D. require specialized knowledge for service delivery and management

Correct Answer: D

Patient safety and medical errors are important concerns for both quality management (QM) and risk management. The following statement(s) can correctly be made about medical errors:
* 1. The complexity of modern medicine and healthcare delivery systems increases patients’ exposure to the risks of medical errors
* 2. Licensing boards for healthcare professionals in all states provide a consistent system of quality oversight and accountability
* 3. Provider compliance with internal incident reporting requirements is low

1. A. All of the above
2. B. 1 and 2 only
3. C. 1 and 3 only
4. D. 3 only

Correct Answer: C

The Shoreside Health Plan recently added coverage for behavioral healthcare services to its benefit package. In order to support the quality of its behavioral healthcare services, Shoreside plans to seek accreditation for its behavioral healthcare program. Accreditation specifically designed for behavioral healthcare programs is available through
* 1.The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
* 2.The National Committee for Quality Assurance (NCQA)
* 3.The American Accreditation HealthCare Commission/URAC (URAC)

1. A. All of the above
2. B. 1 and 2 only
3. C. 2 and 3 only
4. D. 1 only

Correct Answer: B

The Hall Health Plan gathered objective clinical information about the recommended uses and dosages of angiotensin-converting enzyme (ACE) inhibitors and presented the information to network providers to illustrate the appropriate use of these frequently prescribed and expensive drugs. This information indicates that Hall most likely educated its network providers through the use of

1. A. detailing
2. B. cognitive services
3. C. counter detailing
4. D. drug efficacy study implementation (DESI)

Correct Answer: C

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.

1. 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.
2. B. Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several times each day.
3. C. Caroline Evans has severe arthritis that requires regular exercise and oral medication to reduce pain and help her maintain mobility.
4. D. Oscar Gracken is recovering from a heart attack and requires ongoing cardiac rehabilitation.

Correct Answer: A