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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

The Brighton Health Plan regularly performs prospective UR for surgical procedures. Brighton’s prospective UR activities are likely to include

Options:

A.

documenting the clinical details of the patient’s condition and care

B.

tracking the length of inpatient stay

C.

completing the discharge planning process

D.

determining the most appropriate setting for the proposed course of care

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Question 2

This agency’s accreditation decisions are based on the results of an on-site survey of clinical and administrative systems and processes, as well as the health plan’s performance on selected effectiveness of care and member satisfaction measures.

Options:

A.

American Accreditation HealthCare Commission/URAC (URAC)

B.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

C.

Community Health Accreditation Program (CHAP)

D.

National Committee for Quality Assurance (NCQA)

Question 3

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

Options:

A.

evaluating and selecting drugs for inclusion in the formulary

B.

overseeing the manufacture, distribution, and marketing of prescription drugs

C.

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

D.

all of the above

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