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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
Updated On : Click to Check Update
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AHM-540 Questions and Answers

Microsoft Word - AHM-540-Final.html

QUESTION: 155

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


QUESTION: 156

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


QUESTION: 157

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


    image

    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


QUESTION: 159

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


image

QUESTION: 160

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


image

QUESTION: 161

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


QUESTION: 162

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


QUESTION: 163

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


Medical AHM-540 Exam (AHM Medical Management) Detailed Information

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Her attorney instructed newshounds prior to now that she was too sick to make choices. Bernard younger, president of the Baltimore city Council, has been serving as acting mayor and may complete the rest of her time period. i am sorry for the hurt that I even have caused to the photograph of Baltimore and the credibility of the workplace of the mayor, Ms. Pugh observed in a press release study aloud by means of her legal professional, Steve Silverman, at a brief information conference that she did not attend. Baltimore deserves a mayor who can stream our amazing city ahead. Maryland Gov. Larry Hogan, who appoints the board of the school of Maryland medical equipment, applauded Ms. Pughs resignation in a post on Twitter. This became the right choice, as it was clear the mayor might now not lead simply, he wrote. The federal and state investigations ought to and may proceed to discover the records. 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. 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