AHIP AHM-540 問題集

質問 1：
In order to achieve changes in outcomes, health plans make changes to existing structures and processes. The introduction of preauthorization as an attempt to control overuse of services is an example of a reactive change. Reactive changes are typically
A. controlled, but they are rarely planned
B. both planned and controlled
C. planned, but they are rarely controlled
D. neither planned nor controlled
正解：A

質問 2：
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
A. provides an exemption for health plans that can demonstrate cost savings of more than 1 percent
B. prohibits health plans from limiting the number of outpatient visits or inpatient days covered under the plan
C. 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
D. requires health plans to offer mental health benefits to all eligible members
正解：C

質問 3：
The delivery of quality, cost-effective healthcare is a primary goal of both group healthcare and workers' compensation programs. One difference between group healthcare and workers' compensation is that workers' compensation
A. provides coverage for a variety of direct and indirect healthcare, disability, and workplace costs
B. places limits on benefits by restricting the amount of benefit payments or the number of covered hospital days or provider office visits
C. manages costs by including employee cost-sharing features in its benefit design
D. provides health and disability benefits to employees injured on the job only if the employer is at fault for the injury
正解：A

質問 4：
The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.
Definitions of quality healthcare vary; however, four dimensions are essential to quality healthcare services. ________________ is the quality dimension indicating that services result in the best care for a given cost or the lowest cost for a given level of care.
A. Efficiency
B. Effectiveness
C. Acceptability
D. Accessibility
正解：A

質問 5：
Administrative action plans are used when performance problems or opportunities are related to the way the organization itself operates. The following statement(s) can correctly be made about administrative action plans:
1.Administrative action plans allow health plans to coordinate management activities
2.One function of administrative action plans is to integrate service across all levels of the organization
3.Administrative action plans are designed to improve outcomes by helping plan members assume responsibility for their own health
A. 1 and 3 only
B. 1 and 2 only
C. 2 and 3 only
D. All of the above
正解：B

質問 6：
Three general categories of coverage policy-medical policy, benefits administration policy, and administrative policy-are used in conjunction with purchaser contracts to determine a health plan's coverage of healthcare services and supplies. With respect to the characteristics of the three types of coverage policy, it is correct to say that a health plan's
A. benefits administration policy determines whether a particular service is experimental or investigational
B. benefits administration policy focuses on both clinical and nonclinical coverage issues
C. medical policy evaluates clinical services against specific benefits language rather than against scientific evidence
D. administrative policy contains the guidelines to be followed when handling member and provider complaints and disputes
正解：D