AHIP Medical Management - AHM-540무료 덤프문제 풀어보기
7. One method that health plans use to address provider compliance with formularies is academic detailing.
정답: A
Various government and independent agencies have created tools to measure and report the quality of healthcare. One performance measurement tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) is
정답: C
The following statements are about health plans' development of medical policies. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
정답: A
The BBA of 1997 allows states to provide Medicaid benefits to children through the State Children's Health Insurance Program (SCHIP). Under the terms of the BBA, states can implement SCHIP as
1.Part of their existing Medicaid programs
2.Separate commercial insurance programs
1.Part of their existing Medicaid programs
2.Separate commercial insurance programs
정답: D
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
If Ms. Stanley agrees to the generic substitution, she will receive a drug that
정답: A
The following statement(s) can correctly be made about the characteristics of peer review: 1.Peer review is applicable to either single episodes of care or to entire programs of care 2.Most peer review is conducted concurrently
3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
정답: A
The following statement(s) can correctly be made about utilization guidelines:
1.When developing utilization guidelines, health plans balance evidence-based criteria with experience-based criteria
2.Utilization guidelines indicate when a UR nurse should refer a decision to a physician reviewer
1.When developing utilization guidelines, health plans balance evidence-based criteria with experience-based criteria
2.Utilization guidelines indicate when a UR nurse should refer a decision to a physician reviewer
정답: D
Comparing the quality of managed Medicare programs with the quality of FFS Medicare programs is often difficult. Unlike FFS Medicare, managed Medicare programs
정답: A
In order to provide a true measure of quality, the data collected by a quality indicator should accurately represent the service dimension being measured. This information indicates that the indicator should exhibit the characteristic known as
정답: A