AHIP AHM-540 - Medical Management Exam
Page: 2 / 33
Total 163 questions
Question #6 (Topic: )
Performance variance can be classified as either common cause variance or special cause
variance. The following statement(s) can correctly be made about special cause variance:
1.Inadequate staffing levels, employee errors, and equipment malfunctions are examples of
special cause variance
2.Special cause variance is typically more difficult to detect and correct than is common
cause variance
variance. The following statement(s) can correctly be made about special cause variance:
1.Inadequate staffing levels, employee errors, and equipment malfunctions are examples of
special cause variance
2.Special cause variance is typically more difficult to detect and correct than is common
cause variance
A. Both 1 and 2
B. 1 only
C. 2 only
D. Neither 1 nor 2
Answer: B
Question #7 (Topic: )
The Quality Assessment Performance Improvement (QAPI) is a quality initiative designed
to strengthen health plans efforts to protect and improve the health and satisfaction of
Medicare and Medicaid health plan enrollees. The Centers for Medicare and Medicaid
Services (CMS) requires compliance with QAPI from
to strengthen health plans efforts to protect and improve the health and satisfaction of
Medicare and Medicaid health plan enrollees. The Centers for Medicare and Medicaid
Services (CMS) requires compliance with QAPI from
A. both Medicare+Choice plans and Medicaid health plans
B. Medicare+Choice plans only
C. Medicaid health plans only
D. neither Medicare+Choice plans nor Medicaid health plans
Answer: B
Question #8 (Topic: )
A health plan's preventive care initiatives may be classified into three main categories:
primary prevention, secondary prevention, and tertiary prevention. Secondary prevention
refers to activities designed to
primary prevention, secondary prevention, and tertiary prevention. Secondary prevention
refers to activities designed to
A. develop an appropriate treatment strategy for patients whose conditions require extensive, complex healthcare
B. educate and motivate members to prevent illness through their lifestyle choices
C. prevent the occurrence of illness or injury
D. detect a medical condition in its early stages and prevent or at least delay disease progression and complications
Answer: D
Question #9 (Topic: )
Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To
treat Ms. Rays condition, her physician has prescribed Upzil, a medication that has Food
and Drug Administration (FDA) approval only for the treatment of depression. Upzil has not
been tested for safety or effectiveness in the treatment of migraine headache. Although
Harbraces medical policy for migraine headache does not include coverage of Upzil,
Harbrace has agreed to provide extra-contractual coverage of Upzil for Ms. Ray.
The following statement(s) can correctly be made about Harbraces use of extra-
contractual coverage:
1.Harbraces medical policy most likely establishes the procedure that Harbrace used to
evaluate the value of Upzil for treating Ms. Ray
2.One way for Harbrace to reduce the risk associated with extra-contractual coverage is by
including an alternative care provision in its contracts with purchasers
treat Ms. Rays condition, her physician has prescribed Upzil, a medication that has Food
and Drug Administration (FDA) approval only for the treatment of depression. Upzil has not
been tested for safety or effectiveness in the treatment of migraine headache. Although
Harbraces medical policy for migraine headache does not include coverage of Upzil,
Harbrace has agreed to provide extra-contractual coverage of Upzil for Ms. Ray.
The following statement(s) can correctly be made about Harbraces use of extra-
contractual coverage:
1.Harbraces medical policy most likely establishes the procedure that Harbrace used to
evaluate the value of Upzil for treating Ms. Ray
2.One way for Harbrace to reduce the risk associated with extra-contractual coverage is by
including an alternative care provision in its contracts with purchasers
A. Both 1 and 2
B. 1 only
C. 2 only
D. Neither 1 nor 2
Answer: C
Question #10 (Topic: )
Determine whether the following statement is true or false:
Independent review organizations (IROs) can mediate disputes and offer advisory opinions
to health plans on UR issues, but they cannot render binding decisions on appeals.
Independent review organizations (IROs) can mediate disputes and offer advisory opinions
to health plans on UR issues, but they cannot render binding decisions on appeals.
A. True
B. False
Answer: B
