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: Feb 18, 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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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 2
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The paragraph below contains two pairs of terms in parentheses. Determine which term in eachpair correctly completes the paragraph. Then select the answer choice containing the two termsthat you have chosen.Health plans use both internal and external standards to assess the quality of the services thatthey provide. (Internal / External) standards are based on information such as published industrywideaverages or best practices of recognized industry leaders. Health plans primarily rely on(internal / external) standards to evaluate healthcare services.
Answer: D
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The paragraph below contains two pairs of terms in parentheses. Determine which term in eachpair correctly completes the paragraph. Then select the answer choice containing the two termsthat you have chosen.Health plans use both internal and external standards to assess the quality of the services thatthey provide. (Internal / External) standards are based on information such as published industrywideaverages or best practices of recognized industry leaders. Health plans primarily rely on(internal / external) standards to evaluate healthcare services.
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Question 3
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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 4
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Increased demands for performance information have resulted in the development of various
health plan report cards. With respect to most of the report cards currently available, it is correct to
say
Answer: D
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Increased demands for performance information have resulted in the development of various
health plan report cards. With respect to most of the report cards currently available, it is correct to
say
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Question 5
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Comorbidity can have a significant impact on the effective implementation of disease management
programs. Comorbidity can correctly be defined as the
Answer: D
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Comorbidity can have a significant impact on the effective implementation of disease management
programs. Comorbidity can correctly be defined as the