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AHIP AHM-540 Dumps Questions Answers

AHM-540 exam

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Medical Management

Last Update Mar 28, 2024
Total Questions : 163

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Total Questions : 163

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Medical Management Questions and Answers

Questions 1

As a follow-up to a performance improvement plan for member services, the Stellar Health Plan conducted an evaluation of the success of the plan. Stellar conducted its evaluation as the plan was being carried out. The evaluation focused on specific activities and assessed the relative importance of those activities to the plan as a whole. This information indicates that Stellar’s evaluation of the plan was both

Options:

A.

concurrent and formative

B.

concurrent and summative

C.

retrospective and formative

D.

retrospective and summative

Questions 2

MCOs usually have a formal program for the oversight of delegated activities. The following statements concern typical delegation oversight programs. Select the answer choice containing the correct statement.

Options:

A.

A letter of intent is the contractual document that describes the delegated functions and the responsibilities of the MCO and the delegate.

B.

In most cases, the evaluation of a candidate for delegation is based entirely on the candidate’s application and supporting documentation and does not include an on-site assessment of the candidate.

C.

Under most delegation agreements, an MCO cannot terminate the agreement before the end date stated in the agreement.

D.

One objective for a delegation oversight program is to integrate any delegated activities into the MCO’s overall programs for medical management and other functions.

Questions 3

The BBA of 1997 allows states to provide Medicaid benefits to children through the State Children’s Health Insurance Program (SCHIP). Under the terms of the BBA, states can implement SCHIP as

1. Part of their existing Medicaid programs

2. Separate commercial insurance programs

Options:

A.

Both 1 and 2

B.

1 only

C.

2 only

D.

Neither 1 nor 2