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AHM-540 - AHM Medical Management - Dump Information

Vendor : Medical
Exam Code : AHM-540
Exam Name : AHM Medical Management
Questions and Answers : 163 Q & A
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AHM-540 Questions and Answers

Microsoft Word - AHM-540-Final.html


The following statements are about chronic and disabling conditions among children eligible for Medicaid. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

  1. Children with chronic conditions use more physician and nonphysician professional services than do children in the general population.

  2. The majority of chronic conditions affecting children in Medicaid programs are the same as those affecting children in the general population.

  3. Medicaid-eligible children are at risk for seriousmental and physical conditions.

  4. Children in Medicaid programs have a higher incidence of chronic disabling conditions than do children in the general population.

Answer: B


Determine whether the following statement is true or false:

The key to successfully managing the quality and cost-effectiveness of healthcare services for Medicaid enrollees is to merge Medicaid recipients into existing plans.

  1. True

  2. False

Answer: B


Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the

  1. lack of qualified providers in provider networks

  2. lack of resources necessary to establish case management programs for patients with complex conditions

  3. unstable eligibility status of Medicaid recipients

  4. inability of Medicaid recipients to change health plans or PCPs

    Answer: C


    QUESTION: 158

    The following statement(s) can correctly be made about medical management considerations for the Federal Employee Health Benefits Program (FEHBP):

    1. FEHBP plan members who have exhausted the health plan’s usual appeals process for a disputed decision can request an independent review by the Office of Personnel Management (OPM)

    2. All health plans that cover federal employees are required to develop and implement patient safety initiatives

      1. Both 1 and 2

      2. 1 only

      3. 2 only

      4. Neither 1 nor 2

Answer: A


Serena Wilson, a registered nurse, is employed at a TRICARE Service Center (TSC) located at a military installation. Ms. Wilson serves as a primary point of contact between enrollees and the TRICARE system and answers enrollees’ questions about plan options, eligibility, provider selection, and claims. This information indicates that Ms. Wilson serves as a

  1. lead agent

  2. beneficiary services representative

  3. health plan support contractor

  4. primary care manager (PCM)

Answer: B



The paragraph below contains two pairs of terms or phrases enclosed in parentheses. Select the term or phrase in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms or phrases you have chosen.

TRICARE enrollees have the right to challenge authorization and coverage decisions. Such challenges are referred to as (appeals / grievances) and are typically handled by the (TRICARE contractor / Area Field Office).

  1. appeals / TRICARE contractor

  2. appeals / Area Field Office

  3. grievances / TRICARE contractor

  4. grievances / Area Field Office

Answer: A



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

  1. provides health and disability benefits to employees injured on the job only if the employer is at fault for the injury

  2. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs

  3. manages costs by including employee cost-sharing features in its benefit design

  4. places limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits

Answer: B


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

  1. applying strict definitions of medical necessity

  2. developing prevention and recovery programs

  3. applying out-of-network benefit reductions

  4. all of the above

Answer: B


Occasionally, employers combine workers’ compensation, group healthcare, and disability

programs into an integrated product known as 24-hour coverage. One true statement about 24- hour coverage is that it typically

  1. increases administrative costs

  2. requires plans to maintain separate databases of patient care information

  3. exempts plans from complying with state workers’ compensation regulations

  4. allows plans to apply disability management and return-to-work techniques to nonoccupational conditions

Answer: D

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Ms. Pugh has been beneath intense scrutiny seeing that March, when The Baltimore solar reported that she became one in every of 9 contributors of the board of the tuition of Maryland scientific device who had profited in my opinion from contracts with the health facility gadget. When the scandal broke, Ms. Pugh maintained that there was nothing illegal or unethical about her deal to sell her healthy Holly babiess books, which promote nutritious food and exercise, to the health center community. The books had been to be donated to Baltimore colleges and day cares. She apologized for failing to document the deal on disclosure varieties when she become a state senator and back essentially the most contemporary charge of $100,000. but questions endured to swirl over who approved the contract and how most of the books truly reached infants, primarily after thousands of books have been discovered untouched in a college warehouse. Ms. Pugh has obtained $500,000 when you consider that 2011 from the medical gadget for the books. different entities, together with Kaiser Permanente, reportedly paid her an extra $one hundred ninety,000 for the books. This complete entire episode has been hurtful to the metropolis, said Jill Carter, a state senator representing Baltimore who has been pushing to limit self-dealing on the clinic communitys board. these of us who're holding elected workplace now, it is incumbent upon us to do every little thing in our energy to restore the public have confidence. Ms. Carter talked about she all started investigating the medical institution communitys contracts after hearing complaints from minority-owned businesses that it changed into unimaginable for them to bid on contracts, while politically related board participants got lucrative deals that did not go through normal channels of procurement. Ms. Carter referred to that different board participants reaped way more from the health facility network, including Francis X. Kelly, who endorsed the privatization of the sanatorium community as a state senator, and went on to acquire $16 million in contracts via his assurance business, Kelly & pals assurance group. Its been very troubling to me that so a good deal center of attention has been placed on the mayor that there was too little scrutiny and too little need to investigate the other contributors, Ms. Carter mentioned. The sanatorium communitys website lists Mr. Kelly as being on go away from the board, along with three different participants who had enterprise contracts. He did not return a call searching for comment Thursday. A contemporary invoice passed by Marylands prevalent meeting will exchange the clinical equipments total board in July, and usually prohibits future board contributors from receiving no-bid contracts. Michael Schwartzberg, a spokesman for the medical systems administration, observed it could not be issuing a press release on the mayors resignation. Ms. Pugh, who was elected mayor in 2016, has lengthy been a fixture within the citys politics. She up to now served as a state senator and majority leader in Marylands everyday meeting. Her resignation comes after a series of different corruption scandals in the city have shaken religion in Baltimores executive. remaining yr, six Baltimore law enforcement officials pleaded guilty in a wide-ranging corruption trial that covered robbing a motorist of $25,000 and dumping garbage bags crammed with stolen prescription drugs in the marketplace. The metropolis, which endured riots and unrest within the wake of the 2015 loss of life in police custody of Freddie gray, a 25-yr-historical black man, has seen 4 police commissioners cycle through seeing that Mr. grays loss of life. ultimate year, former police commissioner Darryl De Sousa pleaded responsible in federal court docket to failing to file income tax returns. In 2010, a different Baltimore mayor, Sheila Ann Dixon, resigned after being discovered responsible of misappropriating gift cards for the terrible. Joanne Antoine, govt director of commonplace trigger Maryland, a nonpartisan watchdog organization, talked about her community has obtained a number of calls from people expressing a loss of faith in Ms. Pugh. however Ms. Antoine referred to she is heartened by using recent proposals brought via Baltimore metropolis Council members to tighten ethics disclosure suggestions and make it easier to get rid of the mayor. 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