Free AHIP AHM-540 Exam Questions

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

The following statement(s) can correctly be made about the scope of case management:1. Case management incorporates activities that may fall outside a health plan’s typicalresponsibilities, such as assessing a member’s financial situation2. Case management generally requires a less comprehensive and complex approach to a courseof care than does utilization review3. Case management is currently applicable only to medical conditions that require inpatienthospital care and are categorized as catastrophic in terms of health and/or costs 

Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated care plans (CCPs). Unlike other coverage options, CCPs  

The following statement(s) can correctly be made about the scope of case management:1. Case management incorporates activities that may fall outside a health plan’s typicalresponsibilities, such as assessing a member’s financial situation2. Case management generally requires a less comprehensive and complex approach to a courseof care than does utilization review3. Case management is currently applicable only to medical conditions that require inpatienthospital care and are categorized as catastrophic in terms of health and/or costs 

Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treatMs. Ray’s condition, her physician has prescribed Upzil, a medication that has Food and DrugAdministration (FDA) approval only for the treatment of depression. Upzil has not been tested forsafety or effectiveness in the treatment of migraine headache. Although Harbrace’s medical policyfor migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extracontractualcoverage of Upzil for Ms. Ray.In this situation, the prescribing of Upzil for Ms. Ray’s headaches is an example of