Online Access Free AHM-540 Exam Questions

Most health plans require a PCP referral or precertification for CAM benefits.

• A.True
• B.False

The following statements are about risk management for case management. Three of the
statements are true and one is false. Select the answer choice containing the FALSE statement.

• A.A case management file cannot be used to support the health plan's position in the event of a lawsuit.
• B.Case management that is initiated after a member has incurred substantial medical expenses is more likely to be viewed as a tool to cut costs rather than to improve outcomes.
• C.The use of a signed consent authorization form is consistent with accrediting agency standards for patient privacy and confidentiality of medical information.
• D.Health plan documents indicating that any case management delegates are separate, independent entities may reduce an health plan's exposure to risk.

Since its inception, Medicare has undergone a number of changes because of legal and regulatory action. One result of the Balanced Budget Act (BBA) of 1997 has been to

• A.increase the number of "zero premium" plans available to Medicare beneficiaries
• B.encourage growth of managed Medicare programs in all markets
• C.expand Medicare benefits by mandating coverage for certain preventive services
• D.reduce the number of organizations that can deliver covered services

The paragraph below contains two pairs of terms enclosed in parentheses. Select the term in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms you have chosen.
A primary distinction between skilled care and subacute care relates to the extent and medical complexity of the patient's needs. Generally, subacute care patients require (more / fewer) services from physicians and nurses and (more / less) extensive rehabilitation services than do skilled care patients.

• A.fewer / less
• B.fewer / more
• C.more / less
• D.more / more

Health plans arrange for the delivery of various levels of healthcare, including 1.Emergency care 2.Urgent care 3.Primary care delivered in a provider's office
In a ranking of these levels of care according to cost, beginning with the least expensive level of care and ending with the most expensive level of care, the correct order would be

• A.2-3-1
• B.1-2-3
• C.3-2-1
• D.3-1-2