AHIP AHM-540 Quiz 1 Topic 3 Questions 1-5

Question: 1

In order to achieve changes in outcomes, health plans make changes to existing structures and processes. The introduction of preauthorization as an attempt to control overuse of services is an example of a reactive change. Reactive changes are typically

Aboth planned and controlled

Bplanned, but they are rarely controlled

Ccontrolled, but they are rarely planned

Dneither planned nor controlled

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Question: 2

One way that health plans can make their benefits more appealing to employers and employees is to offer coverage for specialty services. It is correct to say that specialty services typically

Ainvolve the same types of providers and delivery systems as do standard medical services

Bare a subset of a health plan's standard medical-surgical services

Care not monitored by health plans for quality or utilization

Drequire specialized knowledge for service delivery and management

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Question: 3

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

Ways that workers' compensation health plans can help control the costs of job-related injuries and illnesses include

Aapplying strict definitions of medical necessity

Bdeveloping prevention and recovery programs

Capplying out-of-network benefit reductions

Dall of the above

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Question: 4

Among this agency's accreditation programs are accreditation for preferred provider organizations (PPOs), health plan call centers, and case management organizations. This agency classifies its standards as either ''shall'' standards or ''should'' standards.

AAmerican Accreditation HealthCare Commission/URAC (URAC)

BJoint Commission on Accreditation of Healthcare Organizations (JCAHO)

CCommunity Health Accreditation Program (CHAP)

DNational Committee for Quality Assurance (NCQA)

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Question: 5

The following statements are about the use of provider profiling for pharmacy benefits. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

AHealth plans typically use provider profiles to improve the quality of care associated with the use of prescription drugs.

BProvider profiles identify prescribing patterns that fall outside normal ranges.

CHealth plans can motivate providers to change their prescribing patterns by sharing profile information with plan members and the general public.

DProvider profiles are effective in modifying individual prescribing patterns, but they have little effect on group prescribing patterns.

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AHIP AHM-540 Quiz:1 Topic:3 Questions:1-5