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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Roosevelt

2 days 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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Vincenza

3 days 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

12 days 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

18 days 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

19 days ago

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

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