AHIP Exam AHM-540 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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Theron

1 months 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 months 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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Maile

7 days ago

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

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Mi

2 months 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

7 days ago

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

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Herman

9 days ago

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

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Tiffiny

1 months ago

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

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Roosevelt

2 months 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

5 days ago

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

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Gwenn

10 days ago

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

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Antione

1 months ago

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

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Anika

1 months ago

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

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Vincenza

2 months 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

2 months 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

2 months 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

2 months ago

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

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