AHM-540 試験問題を無料オンラインアクセス

Various government and independent agencies have created tools to measure and report the quality of healthcare. One performance measurement tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) is

• A.HEDIS, which is a performance measurement tool that addresses both effectiveness of care and plan member satisfaction
• B.the Health Plan Employer Data and Information Set (HEDIS@), which is a report card system for hospitals and long-term care facilities
• C.the Consumer Assessment of Health Plans (CAHPS@), which was established to develop and implement a national strategy for quality measurement and reporting
• D.CAHPS, which is a tool that measures consumer satisfaction with specific aspects of health plan services

Breanna Osborn is a case manager for a regional health plan. One component of Ms. Osborn's job is the collection and evaluation of medical, financial, social, and psychosocial information about a member's situation. This component of Ms. Osborn's job is known as

• A.healthcare coordination
• B.case management planning
• C.case assessment
• D.case identification

The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph.
Each quality standard used by a health plan is associated with quality indicators. A ______________ indicator is a form of aggregate data indicator that produces results that fit within a specified range, such as the length of time to schedule an appointment.

• A.continuous variable
• B.sentinel event
• C.discrete variable
• D.yes/no

The following statement(s) can correctly be made about the characteristics of peer review: 1.Peer review is applicable to either single episodes of care or to entire programs of care 2.Most peer review is conducted concurrently
3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans

• A.All of the above
• B.1 and 2 only
• C.2 and 3 only
• D.1 and 3 only

CMS has developed two prototype programs-Programs of All-inclusive Care for the Elderly (PACE) and the Social Health Maintenance Organization (SHMO) demonstration project-to deliver healthcare services to Medicare beneficiaries. From the answer choices below, select the response that correctly identifies the features of these programs.

• A.PACE-enrollment open to nursing home certifiable Medicare beneficiaries only SHMO-enrollment open to all Medicare beneficiaries
• B.PACE-enrollees must be age 65 or older SHMO-enrollees must be age 55 or older
• C.PACE-annual limits on benefits for nursing home and community-based care SHMO-no limits on long-term care benefits
• D.PACE-provide long-term care only SHMO-provide acute and long-term care