AHIP AHM Medical Management AHM-540 Exam Questions

Nilay Sharma suffered a small wound while working in his yard and was taken to a local hospital for treatment. A triage nurse at the hospital evaluated Mr. Sharma's condition and directed him to an outpatient unit in the hospital where a physician assistant examined, cleaned, and sutured the wound. Mr. Sharma returned home following treatment. The care Mr. Sharma received at the hospital is an example of the type of care known as

Performance variance can be classified as either common cause variance or special cause variance. The following statement(s) can correctly be made about special cause variance:

Inadequate staffing levels, employee errors, and equipment malfunctions are examples of special cause variance

Special cause variance is typically more difficult to detect and correct than is common cause variance

Determine whether the following statement is true or false:

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

Health plans arrange for the delivery of various levels of healthcare, including

Emergency care

Urgent care

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

Selene Varga is participating in her health plan's disease management program for congestive heart failure. Ms. Varga's health status is regularly monitored and managed by a licensed nurse who visits Ms. Varga at her home to administer treatment and assess the need for changes in Ms. Varga's overall care plan. This information indicates that Ms. Varga is participating in the type of disease management program known as a

The following statement(s) can correctly be made about the scope of case management:

Case management incorporates activities that may fall outside a health plan's typical responsibilities, such as assessing a member's financial situation

Case management generally requires a less comprehensive and complex approach to a course of care than does utilization review

Case management is currently applicable only to medical conditions that require inpatient hospital care and are categorized as catastrophic in terms of health and/or costs

For this question, if answer choices (1) through (3) are all correct, select answer choice (4). Otherwise, select the one correct answer choice.

Health plans sometimes delegate selected medical management activities to their providers or other external entities. Activities that are frequently delegated include