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

Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

The document that Mr. Farrell is using to communicate his end-of-life healthcare wishes to his family is known as a

A. medical power of attorney

B. patient assessment and care plan

C. living will

D. healthcare proxy

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

A. lack of qualified providers in provider networks

B. lack of resources necessary to establish case management programs for patients with complex conditions

C. unstable eligibility status of Medicaid recipients

D. inability of Medicaid recipients to change health plans or PCPs

The following statements are about health plans' use of electronic data interchange (EDI). Three of the statements are true and one is false. Select the answer choice containing the FALSE ALSE statement.

A. One advantage of EDI over manual data management systems is improved data integrity.

B. EDI may use the Internet as the communication link between the participating parties.

C. EDI involves back-and-forth exchanges of information concerning individual transactions.

D. The data format for EDI is agreed upon by the sending and receiving parties.

Patient safety and medical errors are important concerns for both quality management (QM) and risk management. The following statement(s) can correctly be made about medical errors:

1.The complexity of modern medicine and healthcare delivery systems increases patients' exposure to the risks of medical errors

2.Licensing boards for healthcare professionals in all states provide a consistent system of quality oversight and accountability

3.Provider compliance with internal incident reporting requirements is low

A. All of the above

B. 1 and 2 only

C. 1 and 3 only

D. 3 only

The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to

A. remove behavioral healthcare services from the primary care setting

B. shift behavioral healthcare from acute inpatient settings to alternative settings when feasible

C. reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient

D. offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members

In order to be effective, a clinical pathway must improve quality and decrease costs.

A. True

B. False

Determine whether the following statement is true or false:

The utilization review (UR) process produces the greatest number of case management referrals.

A. True

B. False

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.

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)

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)