Question 1

The paragraph below contains two pairs of terms in parentheses. Determine which term in each

pair correctly completes the paragraph. Then select the answer choice containing the two terms

that you have chosen.

Health plans use both internal and external standards to assess the quality of the services that

they provide. (Internal / External) standards are based on information such as published industrywide

averages or best practices of recognized industry leaders. Health plans primarily rely on

(internal / external) standards to evaluate healthcare services.

Options :

A : Internal / internal

B : Internal / external

C : External / internal

D : External / external

Answer: D

Question 2

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

Options :

A : must pay the entire cost of the examination

B : must obtain a referral to a dentist from her primary care provider (PCP)

C : can schedule the examination without preauthorization of payment by the DHMO

D : can schedule an unlimited number of examinations and cleanings per year

Answer: C

Question 3

Health plans that choose to contract with external organizations for pharmacy services typically

contract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for a

health plan include

1. Managing the costs of prescription drugs

2. Promoting efficient and safe drug use

3. Determining the health plan’s internal management responsibilities for pharmacy services

Options :

A : All of the above

B : 1 and 2 only

C : 2 and 3 only

D : 1 only

Answer: B

Question 4

Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say

Options :

A : that they are focused primarily on health maintenance organization (HMO) plans

B :

that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS) 3.0

C : that they are used to rank the performance of various health plans

D : all of the above

Answer: D

Question 5

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

Options :

A : standard medical-surgical services

B : mental health and substance abuse services

C : services offered to Medicare enrollees as optional supplementary benefits

D : all of the above

Answer: D

Higher Test Marks with Free Online AHM-540 Exam Practice

Buying Options: