Free Access AHIP AHM-540 New Release

Medical Management Questions and Answers

Question 13

Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the

degree to which the progression of a disease or condition is understood

prevalence or rate of a sickness or injury within a given population

degree of severity of a particular disease or condition

presence of a chronic condition or added complication other than the condition that requires medical treatment

Question 14

PBMs are accredited by the same organizations that accredit health plans.

True

False

Question 15

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

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

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

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

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

Question 16

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

evaluating and selecting drugs for inclusion in the formulary

overseeing the manufacture, distribution, and marketing of prescription drugs

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

all of the above