AHM-540 Choice Practice Questions

The following statements are about health plans’ development of medical policies. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

• AA. Technology assessment is applicable only to medical policy development for new medical procedures, devices, drugs, and tests.
• BB. Technology assessment provides the scientific rationale for the medical policy section that specifies when a medical service is appropriate and when it is not.
• CC. The medical policy development process includes both a clinical and an operational review of a proposed medical policy.
• DD. The decision to accept or reject a proposed medical policy often depends on how a new technology compares to currently used interventions.

Health plan performance measures include structure measures, process measures, and outcome measures. The following statements are about the characteristics of these three types of performance measures. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

• AA. The most widely used structure measures relate to physician education and training.
• BB. One advantage of structure measures over process measures is that structures are often linked directly to healthcare outcomes.
• CC. Process measures are useful in identifying underuse, overuse, and inappropriate use of services.
• DD. One disadvantage of outcome measures is that they can be influenced by factors outside the control of the health plan.

The following statements are about the characteristics of a utilization review (UR) program. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

• AA. A primary goal of UR is to address practice variations through the application of uniform standards and guidelines.
• BB. UR evaluates whether the services recommended by a member’s provider are covered under the benefit plan.
• CC. UR recommends the procedures that providers should perform for plan members.
• DD. A health plan’s UR program is usually subject to review and approval by the state insurance and/or health departments.