AHIP AHM-540 Practice Questions| TestInsights

Question 1

Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQA, These NCQA credentialing standards apply to

Achiropractors

Bnaturopaths

Cacupuncturists

Dall of the above

Correct : A

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Achiropractors

Bnaturopaths

Cacupuncturists

Dall of the above

Question 2

Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated care plans (CCPs). Unlike other coverage options, CCPs

Aprovide only those benefits covered by Medicare Part A and Part B

Bare not subject to federal or state regulation

Cplace primary care at the center of the delivery system

Dare structured as indemnity plans

Correct : C

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Aprovide only those benefits covered by Medicare Part A and Part B

Bare not subject to federal or state regulation

Cplace primary care at the center of the delivery system

Dare structured as indemnity plans

Question 3

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

Aexpand Medicare benefits by mandating coverage for certain preventive services

Breduce the number of organizations that can deliver covered services

Cencourage growth of managed Medicare programs in all markets

Dincrease the number of ''zero premium'' plans available to Medicare beneficiaries

Correct : A

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Aexpand Medicare benefits by mandating coverage for certain preventive services

Breduce the number of organizations that can deliver covered services

Cencourage growth of managed Medicare programs in all markets

Dincrease the number of ''zero premium'' plans available to Medicare beneficiaries

Question 4

Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of

Acase management

Bgeriatric evaluation and management (GEM)

Cintervention identification

Dinterdisciplinary home care (IHC)

Correct : C

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Acase management

Bgeriatric evaluation and management (GEM)

Cintervention identification

Dinterdisciplinary home care (IHC)

Question 5

The delivery of quality, cost-effective healthcare is a primary goal of both group healthcare and workers' compensation programs. One difference between group healthcare and workers' compensation is that workers' compensation

Aprovides health and disability benefits to employees injured on the job only if the employer is at fault for the injury

Bprovides coverage for a variety of direct and indirect healthcare, disability, and workplace costs

Cmanages costs by including employee cost-sharing features in its benefit design

Dplaces limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits

Correct : B

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Aprovides health and disability benefits to employees injured on the job only if the employer is at fault for the injury

Bprovides coverage for a variety of direct and indirect healthcare, disability, and workplace costs

Cmanages costs by including employee cost-sharing features in its benefit design

Dplaces limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits

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