Free AHM-540 Exam Braindumps

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

1. A. provide only those benefits covered by Medicare Part A and Part B
2. B. are not subject to federal or state regulation
3. C. place primary care at the center of the delivery system
4. D. are structured as indemnity plans

Correct Answer: C

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

1. A. chiropractors
2. B. naturopaths
3. C. acupuncturists
4. D. all of the above

Correct Answer: A

One true statement about state regulation of case management activities is that the majority of states

1. A. have enacted laws that list specific quality management requirements for a case management program
2. B. consider case management files to be medical records that must be retained for a specified length of time
3. C. view case management similarly and follow similar patterns with their laws and regulations
4. D. have enacted laws or regulations requiring licensure or certification of case managers

Correct Answer: B

Breanna Osborn is a case manager for a regional health plan. One component of Ms. Osborn’s job is the collection and evaluation of medical, financial, social, and psychosocial information about a member’s situation. This component of Ms. Osborn’s job is known as

1. A. case identification
2. B. case management planning
3. C. healthcare coordination
4. D. case assessment

Correct Answer: D

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

1. A. identification and removal of unusual cases, such as patients with contraindications to a particular treatment, from consideration
2. B. statistical adjustment of outcome measures to account for differences in the severity of illness or the presence of other medical conditions
3. C. specification of a target population for a procedure and the data collection and analysis methods to be used
4. D. elimination of variation within a patient population by dividing the population into groups that are at a similar level of risk

Correct Answer: D