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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

The Bruin Health Plan is a Social Health Maintenance Organization (SHMO). As an SHMO, Bruin:

Options:

A.

Must provide Medicare participants with standard HMO benefits, as well as with limited long-term care benefits

B.

Does not need as great a variety of provider types or as complex a reimbursement method as does a traditional HMO

C.

Receives a payment that is based on reasonable costs and reasonable charges

D.

Most likely provides fewer supportive services than does a traditional HMO, because one of Bruin's goals is to minimize the use of community-based care

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Question 2

The Pine Health Plan has incorporated pharmacy benefits management into its operations to form a unified benefit. Potential advantages that Pine can receive from this action include:

Options:

A.

the fact that unified benefits improve the quality of patient care and the value of pharmacy services to Pine's plan members

B.

the fact that control over the formulary and network contracting can give Pine control over patient access to prescription drugs and to pharmacies

C.

the fact that managing pharmacy benefits in-house gives Pine a better chance to meet customer needs by integrating pharmacy services into the plan's total benefits package

D.

all of the above

Question 3

One reason that an health plan would want to use the actual acquisition cost (AAC) pricing system to calculate its drug costs is that, of the systems commonly used to calculate drug costs, the AAC system

Options:

A.

Provides the lowest level of cost for the health plan

B.

Most closely represents what pharmacies are actually charged for prescription drugs

C.

Offers the best control over multiple-source pharmaceutical products

D.

Is the least expensive pricing system for the health plan to implement