AHM-540 Online Practice Questions and Answers

Acute care refers to healthcare services for medical problems that

A. are expected to continue for a minimum of 30 days

B. are typically treated in a provider's office or outpatient facility

C. require prompt, intensive treatment by healthcare providers

D. require low utilization of resources

By definition, the development and implementation of parameters for the delivery of healthcare services to a health plan's members is known as

A. utilization management (UM)

B. quality management (QM)

C. care management

D. clinical practice management

Accreditation is intended to help purchasers and consumers make decisions about healthcare coverage.

The following statements are about accreditation. Select the answer choice containing the correct statement.

A. At the request of health plans, accrediting agencies gather the data needed for accreditation.

B. Most purchasers and consumers review accreditation results when making decisions to purchase or enroll in a specific health plan.

C. Accreditation is typically conducted by independent, not-for-profit organizations.

D. All health plans are required to participate in the accreditation process.

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

A. lead agent

B. beneficiary services representative

C. health plan support contractor

D. primary care manager (PCM)

Determine whether the following statement is true or false:

All health plans participating in the Federal Employee Health Benefits Program (FEHBP) are required to use the Consumer Assessment of Health Plans (CAHPS) to measure customer satisfaction.

A. True

B. False

To improve members' abilities to make appropriate care decisions about specific medical problems, some health plans use a form of decision support known as telephone triage programs. The following statements are about telephone triage programs. Select the answer choice containing the correct statement.

A. The primary role of telephone triage clinical staff is to diagnose the caller's condition and give medical advice.

B. Quality management (QM) for telephone triage programs typically focuses on the clinical information provided rather than on the quality of service.

C. Currently, none of the major accrediting agencies offers an accreditation program specifically for telephone triage programs.

D. A telephone triage program may also include a self-care component.

This agency's accreditation decisions are based on the results of an on-site survey of clinical and administrative systems and processes, as well as the health plan's performance on selected effectiveness of care and member satisfaction measures.

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)

Breanna Osborn is a case manager for a regional health plan. One component of Ms. Osborn's job is the collection and evaluation of medical, financial, social, and psychosocial information about a member's situation. This component of Ms. Osborn's job is known as

A. case identification

B. case management planning

C. healthcare coordination

D. case assessment

Step-therapy is a form of prior authorization that reserves the use of more expensive medications for cases in which the use of less expensive medications has been unsuccessful. Step-therapy is appropriate for situations in which

1.A significant percentage of those treated with the initial therapy will require the second therapy

2.The delay created when a patient moves from one therapy to the next therapy will not cause serious or permanent effects

A. Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

This agency oversees the Federal Employee Health Benefits Program (FEHBP).

A. Health Resources and Services Administration (HRSA)

B. Office of Personnel Management (OPM)

C. Department of Health and Human Services (HHS)

D. Department of Justice (DOJ)