Free AHM-540 Exam Dumps

Question 16

Benchmarking is a quality improvement strategy used by some health plans. With regard to benchmarking, it is correct to say that

A. cost-based benchmarking reveals why some areas of a health plan perform better or worse than comparable areas of other organizations
B. diagnosis-related groups (DRGs) are a source of benchmarking data that describe individual procedures and cover both inpatient and outpatient care
C. patient billing records provide a much more accurate account of procedure costs for benchmarking than do current procedural terminology (CPT) codes
D. the focus of benchmarking for health plan has shifted from identifying the lowest cost practices to identifying best practices

Correct Answer:D

Question 17

The following statements are about health plans’ use of electronic data interchange (EDI). Three of the statements are true and one is false. Select the answer choice containing the FALSE ALSE statement.

A. One advantage of EDI over manual data management systems is improved data integrity.
B. EDI may use the Internet as the communication link between the participating parties.
C. EDI involves back-and-forth exchanges of information concerning individual transactions.
D. The data format for EDI is agreed upon by the sending and receiving parties.

Correct Answer:C

Question 18

Since its inception, Medicare has undergone a number of changes because of legal and regulatory action. One result of the Balanced Budget Act (BBA) of 1997 has been to

A. expand Medicare benefits by mandating coverage for certain preventive services
B. reduce the number of organizations that can deliver covered services
C. encourage growth of managed Medicare programs in all markets
D. increase the number of “zero premium” plans available to Medicare beneficiaries

Correct Answer:A

Question 19

One way that health plans can make their benefits more appealing to employers and
employees is to offer coverage for specialty services. It is correct to say that specialty services typically

A. involve the same types of providers and delivery systems as do standard medical services
B. are a subset of a health plan’s standard medical-surgical services
C. are not monitored by health plans for quality or utilization
D. require specialized knowledge for service delivery and management

Correct Answer:D

Question 20

To see that utilization guidelines are consistently applied, UR programs rely on authorization systems. Determine whether the following statement about authorization systems is true or false:
Only physicians can make nonauthorization decisions based on medical necessity.

A. True
B. False

Correct Answer:A