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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

Question 1

The case management program director at the Nova Health Plan calculated the program’s ratio of medical expense savings to case management administrative costs for the previous quarter based on the following cost information:

Administrative costs for case management ..........$40,000

Actual medical care expenses for patients under case management ..........$680,000

Projected medical care expenses for the same patients without case management ..........$900,000

This information indicates that, for the previous quarter, Nova’s ratio of medical expense savings to case management administrative costs was

Options:

A.

0.71/1

B.

0.80/1

C.

5.50/1

D.

1.25/1

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Question 2

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

Question 3

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

Options:

A.

must pay the entire cost of the examination

B.

must obtain a referral to a dentist from her primary care provider (PCP)

C.

can schedule the examination without preauthorization of payment by the DHMO

D.

can schedule an unlimited number of examinations and cleanings per year