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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

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Question 1

Health plans often use accreditation as a means of evaluating the quality of care delivered to plan members. Accreditation of subacute care providers is available from the

Options:

A.

National Committee for Quality Assurance (NCQA)

B.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

C.

American Accreditation HealthCare Commission/URAC (URAC)

D.

Foundation for Accountability (FACCT)

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Question 2

The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to

Options:

A.

remove behavioral healthcare services from the primary care setting

B.

shift behavioral healthcare from acute inpatient settings to alternative settings when feasible

C.

reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient

D.

offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members

Question 3

The following statements are about the use of provider profiling for pharmacy benefits. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

Options:

A.

Health plans typically use provider profiles to improve the quality of care associated with the use of prescription drugs.

B.

Provider profiles identify prescribing patterns that fall outside normal ranges.

C.

Health plans can motivate providers to change their prescribing patterns by sharing profile information with plan members and the general public.

D.

Provider profiles are effective in modifying individual prescribing patterns, but they have little effect on group prescribing patterns.

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