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Question ID 17128

The Good & Well Pharmacy, a Medicaid provider of outpatient drugs, is subject to the
prospective drug utilization review (DUR) mandates of the Omnibus Budget Reconciliation
Act of 1990 (OBRA '90). One component of prospective DUR is screening. In this context,
when Good & Well is involved in the process of screening, the pharmacy is

Option A

Updating a formulary to represent the current clinical judgment of providers and experts in the diagnosis and treatment of disease

Option B

Reviewing patient profiles for the purpose of identifying potential problems

Option C

Consulting directly with prescribers and patients in the planning of drug therapy

Option D

Denying coverage for the off-label use of approved drugs

Correct Answer B
Explanation


Question ID 17129

SoundCare Health Services, a health plan, recently conducted a situation analysis. One
step in this analysis required SoundCare to examine its current activities, its strengths and
weaknesses, and its ability to respond to potential threats and opportunities in the
environment. This activity provided SoundCare with a realistic appraisal of its capabilities.
One weakness that SoundCare identified during this process was that it lacked an effective
program for preventing and detectingviolations of law. SoundCare decided to remedy this
weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model
for its compliance program.
With respect to the Federal Sentencing Guidelines, actions that SoundCare should take in
developing its compliance program include

Option A

Creating a system through which employees and other agents can report suspected misconduct without fear of retribution

Option B

Holding management accountable for the misconduct of their subordinates

Option C

 Assigning a high-level member of management to the position of compliance coordinator or administrator

Option D

All of the above

Correct Answer D
Explanation

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