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AHM-530 Exam Dumps : Network Management

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Network Management Questions and Answers

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Question 1

One reason that an health plan would want to use the actual acquisition cost (AAC) pricing system to calculate its drug costs is that, of the systems commonly used to calculate drug costs, the AAC system

Options:

A.

Provides the lowest level of cost for the health plan

B.

Most closely represents what pharmacies are actually charged for prescription drugs

C.

Offers the best control over multiple-source pharmaceutical products

D.

Is the least expensive pricing system for the health plan to implement

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Question 2

The Bruin Health Plan is a Social Health Maintenance Organization (SHMO). As an SHMO, Bruin:

Options:

A.

Must provide Medicare participants with standard HMO benefits, as well as with limited long-term care benefits

B.

Does not need as great a variety of provider types or as complex a reimbursement method as does a traditional HMO

C.

Receives a payment that is based on reasonable costs and reasonable charges

D.

Most likely provides fewer supportive services than does a traditional HMO, because one of Bruin's goals is to minimize the use of community-based care

Question 3

The provider contract that Dr. Laura Cartier has with the Sailboat health plan includes a section known as the recitals. Dr. Cartier's contract includes the following statements:

Options:

A.

A statement that identifies the purpose of the contract

B.

A statement that defines in legal terms the parties to the contract

C.

A statement that identifies the Sailboat products to be covered by the contract

Of these statements, the ones that are likely to be included in the recitals section of Dr. Cartier's contract are statements:

D.

A, B, and C

E.

A and B only

F.

A and C only

G.

B and C only

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