AHIP AHM-540 Exam - Topic 5 Question 93 Discussion

Actual exam question for AHIP's AHM-540 exam

Question #: 93
Topic #: 5

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.

One component of UR is an administrative review. An administrative review compares the proposed medical care to the applicable (medical policy / contract provision). This type of review (can / cannot) be conducted by a nonclinical staff member.

Amedical policy / can

Bmedical policy / cannot

Ccontract provision / can

Dcontract provision / cannot

Show Suggested Answer

Suggested Answer: B

by Melda at Jul 16, 2024, 10:40 AM

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Erinn

7 months ago

Seems odd that nonclinical staff can handle this!

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Tarra

7 months ago

I’m leaning towards contract provision / cannot.

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Fausto

7 months ago

Wait, can nonclinical staff really do that?

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Roslyn

7 months ago

I agree, medical policy is the way to go!

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Huey

8 months ago

Definitely think it's medical policy / can.

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Delfina

8 months ago

I definitely remember that nonclinical staff usually can't make those decisions, so I think that part is "cannot."

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Doug

8 months ago

I feel like "contract provision" might be correct too, but I can't recall if it applies to administrative reviews specifically.

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Colton

8 months ago

I think I practiced a question like this before, and I chose "medical policy" because it seems more relevant to the review process.

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Alida

8 months ago

I remember that administrative reviews are usually based on medical policies, but I'm not sure if nonclinical staff can conduct them.

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Dierdre

8 months ago

Okay, I think I've got this. The key is to identify the relationship between the administrative review and the proposed medical care. The review compares the care to either the medical policy or the contract provision, and a nonclinical staff member can or cannot conduct this type of review. I'll carefully consider each option and select the best answer.

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Marica

8 months ago

Hmm, I'm a bit unsure about this one. The terms "medical policy" and "contract provision" are throwing me off a bit. I'll need to re-read the paragraph and really focus on understanding the context to make the right choice.

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Alysa

8 months ago

This seems like a straightforward question about understanding the context and choosing the correct terms to complete the paragraph. I'll read through it carefully and think about the logic behind each pair of options.

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Freeman

9 months ago

This looks like a tricky one, but I'm feeling confident. I'll read through the paragraph a couple of times, identify the key information, and then logically work through the answer choices to determine the correct terms. I've got this!

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Pamela

9 months ago

Keeping it simple is always a good strategy. Overcomplicated designs can really trip up users.

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Freida

9 months ago

Okay, I think I've got this. The key is to identify the set of responsibilities that match the description given. Based on the options, it looks like C is the best answer - reviewing audit reports to ensure quality and timeliness.

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Glenn

9 months ago

Iâ€™m not totally sureâ€¦ but I think D makes sense because closing questions usually focus on the interview's end, not reducing testimony.

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Theron

1 year ago

Hmm, this question is a real head-scratcher. I'm going to have to go with my gut and say A) medical policy / can. Although, to be honest, I'm just hoping the medical policy can be compared to a good cup of coffee right about now.

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Alyce

1 year ago

This is a tough one, but I'm going with C) contract provision / can. It just makes more sense that the review would be against the contract provision, and a nonclinical staff member can handle the administrative part.

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Antonio

12 months ago

Yes, and having a nonclinical staff member handle the administrative part seems practical.

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Launa

1 year ago

I agree, it does make sense that the review would be against the contract provision.

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Maile

1 year ago

I think you're right, C) contract provision / can seems like the best choice here.

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Mi

1 year ago

D) contract provision / cannot is the way to go. The administrative review needs to be compared to the contract provision, and a nonclinical staff member is not allowed to perform this type of review.

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Larae

1 year ago

That's right. And a nonclinical staff member is not allowed to conduct this type of review.

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Herman

1 year ago

Yes, I agree. The administrative review should be compared to the contract provision.

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Tiffiny

1 year ago

I think D) contract provision / cannot is the correct choice.

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Roosevelt

1 year ago

I think B) medical policy / cannot is the right answer. The administrative review should be compared to the contract provision, not the medical policy, and a nonclinical staff member cannot conduct this review.

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Twana

1 year ago

So the correct answer is D) contract provision / cannot.

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Gwenn

1 year ago

Yes, and a nonclinical staff member cannot conduct this review.

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Antione

1 year ago

I agree, the administrative review should be compared to the contract provision.

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Anika

1 year ago

I think B) medical policy / cannot is the right answer.

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Vincenza

1 year ago

The correct answer is A) medical policy / can. This makes the most sense, as the administrative review would compare the proposed medical care to the established medical policy, and this type of review can be conducted by a nonclinical staff member.

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Launa

1 year ago

I'm not sure about the answer. I think it might be C) contract provision / can. Can someone explain why medical policy is the correct choice?

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Melda

1 year ago

I agree with Hoa. An administrative review can be conducted by a nonclinical staff member if it involves comparing the proposed medical care to the applicable medical policy.

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Hoa

1 year ago

I think the correct answer is A) medical policy / can.

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