AHM-540 Free Practice Test

Economically, health plans cannot provide coverage for every drug available from every manufacturer. As a result, purchaser contracts often include provisions specifying that certain drugs or drug types will not be covered. These provisions are referred to as

1. A. limitations
2. B. exceptions
3. C. exclusions
4. D. drug edits

Correct Answer: C

The following statements are about the use of provider profiling for pharmacy benefits. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

1. A. Health plans typically use provider profiles to improve the quality of care associated with the use of prescription drugs.
2. B. Provider profiles identify prescribing patterns that fall outside normal ranges.
3. C. Health plans can motivate providers to change their prescribing patterns by sharing profile information with plan members and the general public.
4. D. Provider profiles are effective in modifying individual prescribing patterns, but they have little effect on group prescribing patterns.

Correct Answer: D

Health plans often use accreditation as a means of evaluating the quality of care delivered to plan members. Accreditation of subacute care providers is available from the

1. A. National Committee for Quality Assurance (NCQA)
2. B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
3. C. American Accreditation HealthCare Commission/URAC (URAC)
4. D. Foundation for Accountability (FACCT)

Correct Answer: B

Health plans that offer complementary and alternative medicine (CAM) services face potential liability because many types of CAM services

1. A. must be offered as separate supplemental benefits or separate products
2. B. lack clinical trials to evaluate their safety and effectiveness
3. C. are not covered by state or federal consumer protection statutes
4. D. focus on a specific illness, injury, or symptom rather than on the whole body

Correct Answer: B

Serena Wilson, a registered nurse, is employed at a TRICARE Service Center (TSC) located at a military installation. Ms. Wilson serves as a primary point of contact between enrollees and the TRICARE system and answers enrollees’ questions about plan options, eligibility, provider selection, and claims. This information indicates that Ms. Wilson serves as a

1. A. lead agent
2. B. beneficiary services representative
3. C. health plan support contractor
4. D. primary care manager (PCM)

Correct Answer: B