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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

Question 1

As a follow-up to a performance improvement plan for member services, the Stellar Health Plan conducted an evaluation of the success of the plan. Stellar conducted its evaluation as the plan was being carried out. The evaluation focused on specific activities and assessed the relative importance of those activities to the plan as a whole. This information indicates that Stellar’s evaluation of the plan was both

Options:

A.

concurrent and formative

B.

concurrent and summative

C.

retrospective and formative

D.

retrospective and summative

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Question 2

Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute.

If Ms. Stanley agrees to the generic substitution, she will receive a drug that

Options:

A.

has not been tested for safety and efficacy in large clinical trials

B.

is available without a prescription at a reasonable cost

C.

has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective

D.

contains active ingredients that are identical to those of the prescribed brand-name drug

Question 3

The following statements are about medical management considerations for dental care. Select the answer choice containing the correct statement.

Options:

A.

Managed dental care organizations are regulated at the state rather than the federal level.

B.

Dental care differs from medical care in that most dental care is provided by specialists.

C.

Dental preferred provider organizations (Dental PPOs) are subject to more regulation than are dental health maintenance organizations (DHMOs).

D.

Managed dental plans are accredited by the National Association of Dental Plans (NADP).