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AHIP AHM-540 Exam Dumps Questions and Answers

Exam Code: AHM-540
Certification: AHIP Certification
Vendor: AHIP
Last Update: May 6, 2024
Questions: 163
10  Customers Passed AHIP AHM-540
91%  Average Success In Real Exam
88%  Questions came word by word from this dump
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Medical Management Questions and Answers

Questions 1

Among this agency’s accreditation programs are accreditation for preferred provider organizations (PPOs), health plan call centers, and case management organizations. This agency classifies its standards as either “shall” standards or “should” standards.

Options:

A.

American Accreditation HealthCare Commission/URAC (URAC)

B.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

C.

Community Health Accreditation Program (CHAP)

D.

National Committee for Quality Assurance (NCQA)

Questions 2

The following statements are about the characteristics of a utilization review (UR) program. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

Options:

A.

A primary goal of UR is to address practice variations through the application of uniform standards and guidelines.

B.

UR evaluates whether the services recommended by a member’s provider are covered under the benefit plan.

C.

UR recommends the procedures that providers should perform for plan members.

D.

A health plan’s UR program is usually subject to review and approval by the state insurance and/or health departments.

Questions 3

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

Options:

A.

increases administrative costs

B.

requires plans to maintain separate databases of patient care information

C.

exempts plans from complying with state workers’ compensation regulations

D.

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