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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

Question 1

This agency’s accreditation decisions are based on the results of an on-site survey of clinical and administrative systems and processes, as well as the health plan’s performance on selected effectiveness of care and member satisfaction measures.

Options:

A.

American Accreditation HealthCare Commission/URAC (URAC)

B.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

C.

Community Health Accreditation Program (CHAP)

D.

National Committee for Quality Assurance (NCQA)

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Question 2

For this question, if answer choices (a) through (c) are all correct, select answer choice (d). Otherwise, select the one correct answer choice.

Well-crafted clinical practice guidelines (CPGs) can benefit healthcare delivery processes and outcomes by

Options:

A.

providing a framework for care while also allowing for patient-specific variations, based on physician judgment

B.

serving as a basis for evaluating whether providers are practicing in accordance with accepted standards

C.

focusing on the prevention or early detection of a particular condition

D.

all of the above

Question 3

The paragraph below contains two pairs of terms in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.

Health plans use both internal and external standards to assess the quality of the services that they provide. (Internal / External) standards are based on information such as published industry-wide averages or best practices of recognized industry leaders. Health plans primarily rely on (internal / external) standards to evaluate healthcare services.

Options:

A.

Internal / internal

B.

Internal / external

C.

External / internal

D.

External / external