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AHM-540 Practice Questions

Medical Management

Last Update 1 day ago
Total Questions : 163

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Question # 21

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

Options:

A.  

Both 1 and 2

B.  

1 only

C.  

2 only

D.  

Neither 1 nor 2

Discussion 0
Question # 22

Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQ

A.  

These NCQA credentialing standards apply to

Options:

A.  

chiropractors

B.  

naturopaths

C.  

acupuncturists

D.  

all of the above

Discussion 0
Question # 23

The paragraph below contains two pairs of terms or phrases enclosed in parentheses. Determine which term or phrase in each pair correctly completes the paragraph. Then select the answer choice containing the terms or phrases that you have chosen.

The Millway Health Plan received a 15% reduction in the price of a particular pharmaceutical based on the volume of the drug Millway purchased from the manufacturer. This reduction in price is an example of a (rebate / price discount) and (is / is not) dependent on actual provider prescribing patterns.

Options:

A.  

rebate / is

B.  

rebate / is not

C.  

price discount / is

D.  

price discount / is not

Discussion 0
Question # 24

Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treat Ms. Ray’s condition, her physician has prescribed Upzil, a medication that has Food and Drug Administration (FDA) approval only for the treatment of depression. Upzil has not been tested for safety or effectiveness in the treatment of migraine headache. Although Harbrace’s medical policy for migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extra-contractual coverage of Upzil for Ms. Ray.

In this situation, the prescribing of Upzil for Ms. Ray’s headaches is an example of

Options:

A.  

a cosmetic service

B.  

an investigational service

C.  

an off-label use

D.  

a quality-of-life service

Discussion 0
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