Free AHM-540 Exam Braindumps

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

1. A. provides health and disability benefits to employees injured on the job only if the employer is at fault for the injury
2. B. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs
3. C. manages costs by including employee cost-sharing features in its benefit design
4. D. places limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits

Correct Answer: B

By definition, the development and implementation of parameters for the delivery of healthcare services to a health plan’s members is known as

1. A. utilization management (UM)
2. B. quality management (QM)
3. C. care management
4. D. clinical practice management

Correct Answer: D

The Riverside Health Plan is considering the following provider compensation options to use in its contracts with several provider groups and hospitals:
* 1. A discounted fee-for-service (DFFS) payment system
* 2. A case rate system
* 3. Capitation
If Riverside wants to use only those compensation methods that encourage the efficient use of resources, then the compensation method(s) that Riverside should consider for its new contracts include

1. A. 1, 2, and 3
2. B. 1 and 2 only
3. C. 2 and 3 only
4. D. 3 only

Correct Answer: C

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

1. A. applying strict definitions of medical necessity
2. B. developing prevention and recovery programs
3. C. applying out-of-network benefit reductions
4. D. all of the above

Correct Answer: B

One difference between outcomes research and clinical research is that outcomes research

1. A. provides an absolute measure of treatment results, whereas clinical research provides a relative measure of results
2. B. focuses on treatment effectiveness, whereas clinical research focuses on treatmentefficacy
3. C. examines diseases and treatments in isolation, whereas clinical research considers the effects of changes in health status and quality of life
4. D. gathers outcomes data from controlled clinical trials, whereas clinical research collects and analyzes clinical, financial, and administrative data

Correct Answer: B