Free AHIP AHM-540 Exam Questions
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AHIP AHM-540 Exam Questions
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Provided By: AHIP
- Exam: Medical Management (AHM540)
- Certification: AHIP Certification
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Total Questions: 165
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Updated On: Mar 28, 2025
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Rated: 4.9 |
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Online Users: 330
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Question 1
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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
Answer: B
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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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Question 2
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Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health planabout the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrellsigned an advance directive that indicates the types of end-of-life medical treatment he wants toreceive. His family is to use this document as a guide should Mr. Farrell become incapacitated.For this question, if answer choices (A) through (C) are all correct, select answer choice (D).Otherwise, select the one correct answer choice.Decisions regarding Mr. Farrell’s end-of-life care are legally the right and responsibility of
Answer: A
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Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health planabout the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrellsigned an advance directive that indicates the types of end-of-life medical treatment he wants toreceive. His family is to use this document as a guide should Mr. Farrell become incapacitated.For this question, if answer choices (A) through (C) are all correct, select answer choice (D).Otherwise, select the one correct answer choice.Decisions regarding Mr. Farrell’s end-of-life care are legally the right and responsibility of
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Question 3
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For this question, if answer choices (A) through (C) are all correct, select answer choice (D).
Otherwise, select the one correct answer choice.
The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid
and Medicare Services (CMS) initiative designed to strengthen health plans’ efforts to protect and
improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards
apply to
Answer: D
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For this question, if answer choices (A) through (C) are all correct, select answer choice (D).
Otherwise, select the one correct answer choice.
The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid
and Medicare Services (CMS) initiative designed to strengthen health plans’ efforts to protect and
improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards
apply to
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Question 4
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The following statement(s) can correctly be made about the scope of case management:1. Case management incorporates activities that may fall outside a health plan’s typicalresponsibilities, such as assessing a member’s financial situation2. Case management generally requires a less comprehensive and complex approach to a courseof care than does utilization review3. Case management is currently applicable only to medical conditions that require inpatienthospital care and are categorized as catastrophic in terms of health and/or costs
Answer: D
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The following statement(s) can correctly be made about the scope of case management:1. Case management incorporates activities that may fall outside a health plan’s typicalresponsibilities, such as assessing a member’s financial situation2. Case management generally requires a less comprehensive and complex approach to a courseof care than does utilization review3. Case management is currently applicable only to medical conditions that require inpatienthospital care and are categorized as catastrophic in terms of health and/or costs
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Question 5
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Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare
programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated
care plans (CCPs). Unlike other coverage options, CCPs
Answer: C
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Medicare beneficiaries can obtain healthcare benefits through fee-for-service (FFS) Medicare
programs, Medicare medical savings account (MSA) plans, Medigap insurance, or coordinated
care plans (CCPs). Unlike other coverage options, CCPs