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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

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

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

Options:

A.

must pay the entire cost of the examination

B.

must obtain a referral to a dentist from her primary care provider (PCP)

C.

can schedule the examination without preauthorization of payment by the DHMO

D.

can schedule an unlimited number of examinations and cleanings per year

Question 3

In most health plans, the formulary system is developed and managed by a P&T committee. The P&T committee is responsible for

Options:

A.

evaluating and selecting drugs for inclusion in the formulary

B.

overseeing the manufacture, distribution, and marketing of prescription drugs

C.

certifying the medical necessity of expensive, potentially toxic, or nonformulary drugs

D.

all of the above