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Exam Code: AHM-540Exam Name: Medical Management
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AHM-540 Test Answers Total Q&A: 163 Questions and Answers
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Exam Code: AHM-510Exam Name: Governance and Regulation
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AHM-510 Test Questions Total Q&A: 76 Questions and Answers
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NO.1 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.2 Some health plans administer a questionnaire known as the Behavioral Risk Factor Surveillance
System (BRFSS) as part of their health risk assessment (HRA) processes. The following statements are
about the BRFSS. If statements (A) through (C) are all correct, select answer choice (D). Otherwise,
select the one correct statement.
A. This questionnaire was designed specifically for use by health plans.
B. Each health plan must use the same form of the questionnaire, with no additions or modifications.
C. This questionnaire monitors the prevalence of the major behavioral risks associated with illness
and injury among adults.
D. All of the above statements are correct.
Answer: C
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NO.3 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.4 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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NO.5 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.6 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.7 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.8 For this question, if answer choices (A) through (C) are all correct, select answer choice (D).
Otherwise, select the one correct answer choice.
The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and
Medicare Services (CMS) initiative designed to strengthen health plans' efforts to protect and
improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards
apply to
A. standard medical-surgical services
B. mental health and substance abuse services
C. services offered to Medicare enrollees as optional supplementary benefits
D. all of the above
Answer: D
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