Free AHM-540 Exam Braindumps

DUR can be conducted prospectively, concurrently, or retrospectively. One true statement about prospective DUR is that it

1. A. involves periodic audits of the medical records of a certain group of patients
2. B. is based on historical data
3. C. focuses on the drug therapy for a single patient rather than overall usage patterns
4. D. is conducted by physicians, without input from pharmacists

Correct Answer: C

Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.

1. A. The proportion of adult members who are screened for hypertension will increase by ten percent.
2. B. Primary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.
3. C. The QM program director will evaluate the level of provider compliance with clinicalpractice guidelines (CPGs).
4. D. The disease management program director will increase participation by asthmatic children in the health plan’s pediatric asthma disease management program.

Correct Answer: B

Home healthcare encompasses a wide variety of medical, social, and support services delivered at the homes of patients who are disabled, chronically ill, or terminally ill. The time period(s) when health plans typically use home healthcare include
* 1. The period prior to a hospital admission
* 2. The period following discharge from a hospital

1. A. Both 1 and 2
2. B. 1 only
3. C. 2 only
4. D. Neither 1 nor 2

Correct Answer: A

The Mental Health Parity Act (MHPA) of 1996 is a federal law that establishes requirements for behavioral healthcare coverage for group plan members. The MHPA

1. A. requires health plans to offer mental health benefits to all eligible members
2. B. prohibits health plans that offer mental health benefits from imposing lower annual or lifetime dollar limits on mental illnesses than they do on physical illnesses
3. C. provides an exemption for health plans that can demonstrate cost savings of more than 1 percent
4. D. prohibits health plans from limiting the number of outpatient visits or inpatient dayscovered under the plan

Correct Answer: B

Private employers are key purchasers of health plan services. The following statement(s) can correctly be made about employer expectations about the quality and cost- effectiveness of healthcare services:
* 1. For both health maintenance organizations (HMOs) and non-HMO plans, employers typically have access to accreditation results and performance measurement reports to help them evaluate the quality of healthcare and service
* 2. Because of employers’ concern about the quality and costs of healthcare services available through health plans, direct contracting has become a dominant model among employers who sponsor health benefit programs for their employees

1. A. Both 1 and 2
2. B. 1 only
3. C. 2 only
4. D. Neither 1 nor 2

Correct Answer: D