AHIP AHM-540 問題集

質問 1：
Determine whether the following statement is true or false:
All health plans participating in the Federal Employee Health Benefits Program (FEHBP) are required to use the Consumer Assessment of Health Plans (CAHPS) to measure customer satisfaction.
A. False
B. True
正解：B

質問 2：
Elaine Newman suffered an acute asthma attack and was taken to a hospital emergency department for treatment. Because Ms. Newman's condition had not improved enough following treatment to warrant immediate release, she was transferred to an observation care unit. Transferring Ms. Newman to the observation care unit most likely
A. gave Ms. Newman access to more effective and efficient treatment than she could have obtained from other providers in the same region
B. allowed clinical staff an opportunity to determine whether Ms. Newman required hospitalization without actually admitting her
C. resulted in unnecessarily expensive charges for treatment
D. prevented Ms. Newman from receiving immediate attention for her condition
正解：B

質問 3：
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
A. must obtain a referral to a dentist from her primary care provider (PCP)
B. can schedule an unlimited number of examinations and cleanings per year
C. can schedule the examination without preauthorization of payment by the DHMO
D. must pay the entire cost of the examination
正解：C

質問 4：
Determine whether the following statement is true or false:
With respect to the size of a managed care organization (MCO) and its medical management operations, it is correct to say that large health plans typically have more integration among activities and less specialization of roles than do small MCOs.
A. False
B. True
正解：A

質問 5：
The following statement(s) can correctly be made about the characteristics of peer review: 1.Peer review is applicable to either single episodes of care or to entire programs of care 2.Most peer review is conducted concurrently
3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
A. 1 and 3 only
B. 1 and 2 only
C. 2 and 3 only
D. All of the above
正解：A

質問 6：
The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to
A. remove behavioral healthcare services from the primary care setting
B. reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient
C. offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members
D. shift behavioral healthcare from acute inpatient settings to alternative settings when feasible
正解：D