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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

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

Options:

A.

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

B.

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

C.

degree of severity of a particular disease or condition

D.

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

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Question 2

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

Question 3

Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute.

If Ms. Stanley agrees to the generic substitution, she will receive a drug that

Options:

A.

has not been tested for safety and efficacy in large clinical trials

B.

is available without a prescription at a reasonable cost

C.

has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective

D.

contains active ingredients that are identical to those of the prescribed brand-name drug

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