AHM-510コンポーネント、AHM-540認証試験

NO.1 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. expand Medicare benefits by mandating coverage for certain preventive services
B. reduce the number of organizations that can deliver covered services
C. encourage growth of managed Medicare programs in all markets
D. increase the number of "zero premium" plans available to Medicare beneficiaries
Answer: A

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NO.2 To see that utilization guidelines are consistently applied, UR programs rely on authorization
systems. Determine whether the following statement about authorization systems is true or false:
Only physicians can make nonauthorization decisions based on medical necessity.
A. True
B. False
Answer: A

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NO.3 The paragraph below contains an incomplete statement. Select the answer choice containing
the term that correctly completes the paragraph.
Medical management programs often require the analysis of many types of data and information.
__________________ is an automated process that analyzes variables to help detect patterns and
relationships in the data.
A. Unbundling
B. Outsourcing
C. Data mining
D. Drilling down
Answer: C

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NO.4 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. The use of a signed consent authorization form is consistent with accrediting agency standards for
patient privacy and confidentiality of medical information.
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. Health plan documents indicating that any case management delegates are separate, independent
entities may reduce an health plan's exposure to risk.
D. A case management file cannot be used to support the health plan's position in the event of a
lawsuit.
Answer: D

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NO.5 In most health plans, the formulary system is developed and managed by a P&T committee. The
P&T committee is responsible for
A. evaluating and selecting drugs for inclusion in the formulary
B. overseeing the manufacture, distribution, and marketing of prescription drugs
C. certifying the medical necessity of expensive, potentially toxic, or nonformulary drugs
D. all of the above
Answer: A

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NO.6 With respect to the activities of MCO medical directors, it is correct to say that medical
directors typically perform all of the following activities EXCEPT
A. maintaining clinical practices
B. delivering performance feedback to providers
C. participating in utilization management (UM) activities
D. educating other MCO staff about new clinical developments or provider innovations that might
impact clinical practice management
Answer: A

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NO.7 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.
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

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NO.8 To measure performance for quality management, health plans collect and analyze three types
of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can
correctly be made about the sources of clinical data:
1.Patient surveys are the most widely used source of disease-specific clinical information
2.Outcomes research studies sponsored by academic institutions and professional organizations have
limited usefulness for particular health plans or individual providers
3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental
health status
A. All of the above
B. 1 and 2 only
C. 2 and 3 only
D. 3 only
Answer: C

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試験番号：AHM-510
試験科目：「Governance and Regulation」
一年間無料で問題集をアップデートするサービスを提供いたします
最近更新時間：2015-09-23
問題と解答：全76問 AHM-510 学習資料

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試験番号：AHM-540
試験科目：「Medical Management」
一年間無料で問題集をアップデートするサービスを提供いたします
最近更新時間：2015-09-23
問題と解答：全163問 AHM-540 認定テキスト

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