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AHM-540 – Medical Management

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Showing 4–6 of 10 questions

Question 4

Determine whether the following statement is true or false:

The key to successfully managing the quality and cost-effectiveness of healthcare services for Medicaid enrollees is to merge Medicaid recipients into existing plans.

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    True
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    False
Question 5

Many health plans use HRA to target their preventive care programs to the healthcare needs of their members. With regard to HRA, it is correct to say that

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  • ○

    Health plans rarely delegate HRA activities to external entities

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    Health plans typically focus their HRA efforts on newly enrolled members

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    HRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members

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    HRA is generally a reliable predictor of medical resource utilization
Question 6

A health plan’s coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions:

1. In case of conflict between the purchaser contract and a health plan’s medical policy or benefits administration policy, the contract takes precedence

2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies

3. All of the criteria for coverage decisions must be included in the purchaser contract

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  • ○

    All of the above

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    1 and 2 only

  • ○

    2 only

  • ○

    3 only