AHM-540 무료 덤프문제 온라인 액세스
| 시험코드: | AHM-540 |
| 시험이름: | Medical Management |
| 인증사: | AHIP |
| 무료 덤프 문항수: | 163 |
| 업로드 날짜: | 2026-01-01 |
Many health plans use clinical pathways to help manage the delivery of acute care services to plan members. One true statement about clinical pathways is that they
The following statement(s) can correctly be made about accrediting agency standards for delegation:
1.The National Committee for Quality Assurance (NCQA) allows health plans to delegate all medical management functions, including the responsibility to perform delegation oversight activities
2.In some cases, accreditation standards for delegation oversight are reduced if the delegate has already been certified or accredited by the delegator's accrediting agency
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
The paragraph below contains two pairs of terms or phrases enclosed in parentheses. Determine which term or phrase in each pair correctly completes the paragraph. Then select the answer choice containing the terms or phrases that you have chosen.
Due to competitive pressures and consumer demand, many health plans now offer direct access or open access products. Under a direct access product, a member is (required / not required) to select a primary care provider (PCP), and is (required / not required) to
obtain a referral from a PCP or the health plan before visiting a network specialist.
The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.
The Balanced Budget Act (BBA) of 1997 established the use of ___________ to determine coverage of emergency services for Medicare and Medicaid enrollees in health plans.