AHIP AHM Medical Management AHM-540 Exam Practice Test

The following statement(s) can correctly be made about the characteristics of peer review:

Peer review is applicable to either single episodes of care or to entire programs of care

Most peer review is conducted concurrently

Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans

Determine whether the following statement is true or false:

The delegation of medical management functions to providers can occur without the transfer of financial risk.

State governments serve as both regulators and purchasers of health plan services. The influence of state governments as purchasers is focused on

Economically, health plans cannot provide coverage for every drug available from every manufacturer. As a result, purchaser contracts often include provisions specifying that certain drugs or drug types will not be covered. These provisions are referred to as

A health plan's choice of structure measures, process measures, and outcome measures to evaluate performance depends in part on the scientific soundness of the measures. One approach that a health plan can use to enhance scientific soundness is stratification, which refers to the

Administrative action plans are used when performance problems or opportunities are related to the way the organization itself operates. The following statement(s) can correctly be made about administrative action plans:

Administrative action plans allow health plans to coordinate management activities

One function of administrative action plans is to integrate service across all levels of the organization

Administrative action plans are designed to improve outcomes by helping plan members assume responsibility for their own health

Determine whether the following statement is true or false:

Participation in disease management programs is currently voluntary.