AHM-540 Free Practice Test

DUR can be conducted prospectively, concurrently, or retrospectively. One true statement about prospective DUR is that it

1. A. involves periodic audits of the medical records of a certain group of patients
2. B. is based on historical data
3. C. focuses on the drug therapy for a single patient rather than overall usage patterns
4. D. is conducted by physicians, without input from pharmacists

Correct Answer: C

The Brighton Health Plan regularly performs prospective UR for surgical procedures. Brighton’s prospective UR activities are likely to include

1. A. documenting the clinical details of the patient’s condition and care
2. B. tracking the length of inpatient stay
3. C. completing the discharge planning process
4. D. determining the most appropriate setting for the proposed course of care

Correct Answer: D

The Fairview Health Plan uses a dual database approach to integrate information needed for its disease management program. This information indicates that Fairview uses an information management system that

1. A. combines all existing information from all data sources into a single comprehensive system
2. B. connects multiple databases with a central interface engine that acts as an information clearinghouse
3. C. provides an outside vendor with pertinent data that the vendor compiles into an integrated database
4. D. creates a separate database that pulls pertinent information from the health plan’s claims database, formats the information for easy analysis, and stores it in the separate database

Correct Answer: D

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

1. 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.
2. B. Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.
3. C. In order to serve as a hospitalist, a physician must have a background in critical care medicine.
4. D. Hospitalists typically spend at least one-quarter of their time in a hospital setting.

Correct Answer: D

MCOs usually have a formal program for the oversight of delegated activities. The following statements concern typical delegation oversight programs. Select the answer choice containing the correct statement.

1. A. A letter of intent is the contractual document that describes the delegated functions and the responsibilities of the MCO and the delegate.
2. B. In most cases, the evaluation of a candidate for delegation is based entirely on the candidate’s application and supporting documentation and does not include an on-site assessment of the candidate.
3. C. Under most delegation agreements, an MCO cannot terminate the agreement before the end date stated in the agreement.
4. D. One objective for a delegation oversight program is to integrate any delegated activities into the MCO’s overall programs for medical management and other functions.

Correct Answer: D