AHIP AHM-540 - Medical Management Exam
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Total 163 questions
Question #11 (Topic: )
To facilitate electronic commerce (eCommerce), a health plan may establish a secured
extranet. One true statement about a secured extranet is that it is
extranet. One true statement about a secured extranet is that it is
A. based on Web-based technologies
B. available only to the employees of the health plan
C. publicly available, so the potential exists for unauthorized access to a health plans proprietary systems
D. used to handle the majority of health plan eCommerce
Answer: A
Question #12 (Topic: )
The Brighton Health Plan regularly performs prospective UR for surgical procedures.
Brightons prospective UR activities are likely to include
Brightons prospective UR activities are likely to include
A. documenting the clinical details of the patient’s condition and care
B. tracking the length of inpatient stay
C. completing the discharge planning process
D. determining the most appropriate setting for the proposed course of care
Answer: D
Question #13 (Topic: )
Health plans that choose to contract with external organizations for pharmacy services
typically contract with pharmacy benefit managers (PBMs). Functions that a PBM typically
performs for a health plan include
1.Managing the costs of prescription drugs
2.Promoting efficient and safe drug use
3.Determining the health plans internal management responsibilities for pharmacy services
typically contract with pharmacy benefit managers (PBMs). Functions that a PBM typically
performs for a health plan include
1.Managing the costs of prescription drugs
2.Promoting efficient and safe drug use
3.Determining the health plans internal management responsibilities for pharmacy services
A. All of the above
B. 1 and 2 only
C. 2 and 3 only
D. 1 only
Answer: B
Question #14 (Topic: )
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.
problems that require care. Select the statement that describes a situation in which self-
care most likely would not be appropriate.
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.
B. Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several times each day.
C. Caroline Evans has severe arthritis that requires regular exercise and oral medication to reduce pain and help her maintain mobility.
D. Oscar Gracken is recovering from a heart attack and requires ongoing cardiac rehabilitation.
Answer: A
Question #15 (Topic: )
In order for a health plans performance-based quality improvement programs to be
effective, the desired outcomes must be
effective, the desired outcomes must be
A. achievable within a specified timeframe
B. defined in terms of multiple results
C. expressed in subjective, qualitative terms
D. all of the above
Answer: A
