AHIP AHM-540 問題集

質問 1：
The following statements are about the use of hospitalists to manage inpatient care. Select the answer choice containing the correct statement.
A. A patient who has been transferred to a hospitalist for management of inpatient care usually continues to receive care from the hospitalist after discharge.
B. Hospitalists typically spend at least one-quarter of their time in a hospital setting.
C. Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.
D. In order to serve as a hospitalist, a physician must have a background in critical care medicine.
正解：B

質問 2：
The Harbor Health Plan's formulary policy encourages network pharmacists who are asked to fill a prescription for a costly, brand-name drug to dispense a different chemical entity within the same drug class in order to reduce costs. This type of drug substitution is referred to as
A. generic substitution, and prescriber approval is not required
B. generic substitution, and prescriber approval is always required
C. therapeutic substitution, and prescriber approval is always required
D. therapeutic substitution, and prescriber approval is not required
正解：C

質問 3：
Federal laws, such as the Employee Retirement Income Security Act (ERISA), the Balanced Budget Act (BBA) of 1997, and the Health Insurance Portability and Accountability Act (HIPAA), have affected medical management activities by health plans. Consider the following provisions of federal regulations:
Provision 1-Limits damage awards in lawsuits related to noncoverage of benefits based on medical necessity decisions to the cost of noncovered treatment and does not allow health plan members to obtain compensatory or punitive damages
Provision 2-Establishes electronic data security standards, which define the security measures that healthcare organizations must take to protect the confidentiality of electronically stored and transmitted patient information From the answer choices below, select the response that correctly identifies the federal laws that include Provision 1 and Provision 2, respectively.
A. Provision 1- HIPAA Provision 2- ERISA
B. Provision 1- ERISA Provision 2- BBA of 1997
C. Provision 1- BBA of 1997 Provision 2- HIPAA
D. Provision 1- ERISA Provision 2- HIPAA
正解：D

質問 4：
In order for a health plan's performance-based quality improvement programs to be effective, the desired outcomes must be
A. all of the above
B. expressed in subjective, qualitative terms
C. achievable within a specified timeframe
D. defined in terms of multiple results
正解：C

質問 5：
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
A. all of the above
B. that they are focused primarily on health maintenance organization (HMO) plans
C. that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS) 3.0
D. that they are used to rank the performance of various health plans
正解：A

質問 6：
Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell signed an advance directive that indicates the types of end-of-life medical treatment he wants to receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.
The document that Mr. Farrell is using to communicate his end-of-life healthcare wishes to his family is known as a
A. healthcare proxy
B. medical power of attorney
C. living will
D. patient assessment and care plan
正解：C