Most Recent AHIP AHM-540 Exam Dumps

Prepare for the AHIP AHM Medical Management exam with our extensive collection of questions and answers. These practice Q&A are updated according to the latest syllabus, providing you with the tools needed to review and test your knowledge.

QA4Exam focus on the latest syllabus and exam objectives, our practice Q&A are designed to help you identify key topics and solidify your understanding. By focusing on the core curriculum, These Questions & Answers helps you cover all the essential topics, ensuring you're well-prepared for every section of the exam. Each question comes with a detailed explanation, offering valuable insights and helping you to learn from your mistakes. Whether you're looking to assess your progress or dive deeper into complex topics, our updated Q&A will provide the support you need to confidently approach the AHIP AHM-540 exam and achieve success.

The questions for AHM-540 were last updated on Feb 18, 2025.

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Question No. 1

One way that health plans evaluate their UR programs is by monitoring utilization rates. By definition, utilization rates typically

Aindicate changes in the total amount of medical expenses or claim dollars paid for particular procedures

Bmeasure the number of services provided per 1,000 members per year

Cindicate standard approaches to care for many common, uncomplicated healthcare services

Dreport the number of times that a particular provider performs or recommends a service excluded from the benefit plan

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Correct Answer: B

Question No. 2

The BBA of 1997 allows states to provide Medicaid benefits to children through the State Children's Health Insurance Program (SCHIP). Under the terms of the BBA, states can implement SCHIP as

Part of their existing Medicaid programs

Separate commercial insurance programs

ABoth 1 and 2

B1 only

C2 only

DNeither 1 nor 2

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Correct Answer: A

Question No. 3

Drugs included in a health plan's formulary can be classified according to how freely they can be prescribed. By definition, a drug that requires some sort of review or approval by a plan physician or group of physicians before the prescription can be filled is

Aan unrestricted drug

Ba monitored drug

Ca restricted drug

Da conditional drug

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Correct Answer: B

Question No. 4

Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute.

The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.

Greenhouse's prescription drug reimbursement policy indicates that the plan formulary is classified as (open / closed), and that compliance by patients and providers is (mandatory / voluntary).

Aopen / mandatory

Bopen / voluntary

Cclosed / mandatory

Dclosed / voluntary

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Correct Answer: C

Question No. 5

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

ANational Committee for Quality Assurance (NCQA)

BJoint Commission on Accreditation of Healthcare Organizations (JCAHO)

CAmerican Accreditation HealthCare Commission/URAC (URAC)

DFoundation for Accountability (FACCT)

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Correct Answer: B

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