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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

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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

The Medicaid population can be divided into subgroups based on their relative size and the costs of providing benefits. From the answer choices below, select the response that correctly identifies the subgroups that represent the largest percentages of the total Medicaid population and of total Medicaid expenditures. Largest % of Medicaid Population- Largest % of Medicaid Expenditures-

Options:

A.

Largest % of Medicaid Population-dual eligibles Largest % of Medicaid Expenditures-children and low-income adults

B.

Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for MedicareLargest % of Medicaid Expenditures-dual eligibles

C.

Largest % of Medicaid Population-children and low-income adults Largest % of Medicaid Expenditures-chronically ill or disabled individuals not eligible for Medicare

D.

Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for Medicare Largest % of Medicaid Expenditures-children and low-income adults

Question 3

The nature of behavioral healthcare creates unique medical management challenges for health plans. One method health plans have used to support the delivery of appropriate services in a cost-effective manner is to

Options:

A.

remove behavioral healthcare services from the primary care setting

B.

shift behavioral healthcare from acute inpatient settings to alternative settings when feasible

C.

reserve the use of psychotherapy for treatment of those conditions that persist over long periods of time or for the life of the patient

D.

offer the same level of compensation to all of the professional disciplines that provide behavioral healthcare services to plan members

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