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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

Question 1

Martin Breslin, age 72 and permanently disabled, is classified as dually-eligible. This information indicates that Mr. Breslin qualifies for coverage by both

Options:

A.

Medicare and private indemnity insurance, and Medicare provides primary coverage

B.

Medicare and Medicaid, and Medicare provides primary coverage

C.

Medicaid and private indemnity insurance, and Medicaid provides primary coverage

D.

Medicare and Medicaid, and Medicaid provides primary coverage

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Question 2

Dr. Eve Barlow is a specialist in the Amity Health Plan’s provider network. Dr. Barlow’s provider contract with Amity contains a typical most-favored-nation arrangement. The purpose of this arrangement is to

Options:

A.

Require Dr. Barlow and Amity to use arbitration to resolve any disputes regarding the contract

B.

Specify that the contract is to be governed by the laws of the state in which Amity has its headquarters

C.

Require Dr. Barlow to charge Amity her lowest rate for a medical service she has provided to an Amity plan member, even if the rate is lower than the price negotiated in the contract

D.

State that the contract creates an employment or agency relationship, rather than an independent contractor relationship, between Dr. Barlow and Amity

Question 3

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.

A formulary lists the drugs and treatment protocols that are considered to be the preferred therapy for a given managed population. The Fairfax Health Plan uses the type of formulary which covers drugs that are on its preferred list as well as drugs that are not on its preferred list. This information indicates that Fairfax uses the (closed / open) formulary method. In using the formulary approach to pharmacy benefits management, Fairfax most likely experiences (higher / lower) costs for its members’ prescription drugs than it would if it did not use a formulary.

Options:

A.

closed / higher

B.

closed / lower

C.

open / higher

D.

open / lower