Most Recent AHIP AHM-540 Exam Questions & Answers

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 Jan 19, 2025.

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Question No. 1

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.

AHealth plans typically use provider profiles to improve the quality of care associated with the use of prescription drugs.

BProvider profiles identify prescribing patterns that fall outside normal ranges.

CHealth plans can motivate providers to change their prescribing patterns by sharing profile information with plan members and the general public.

DProvider profiles are effective in modifying individual prescribing patterns, but they have little effect on group prescribing patterns.

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Correct Answer: D

Question No. 2

Emilio Martinez, a member of the Bloom Health Plan, has recently been diagnosed with prostate cancer by his physician, Dr. Robert Cohen. Mr. Martinez has decided to participate in Bloom's shared decision-making program for prostate cancer. On the basis of this information, it is most likely correct to say

That verification of Mr. Martinez's understanding about his care options protects both Dr. Cohen and Bloom against charges of malpractice

That Mr. Martinez and Dr. Cohen will discuss the care options available to Mr. Martinez, but the ultimate decision about care is up to Dr. Cohen

ABoth 1 and 2

B1 only

C2 only

DNeither 1 nor 2

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Correct Answer: D

Question No. 3

Vision care is typically separated into two categories: routine eye care and clinical eye care. The standard benefit plans offered by most health plans include coverage for

Routine eye care

Clinical eye care

ABoth 1 and 2

B1 only

C2 only

DNeither 1 nor 2

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Correct Answer: C

Question No. 4

Many health plans use HRA to target their preventive care programs to the healthcare needs of their members. With regard to HRA, it is correct to say that

AHealth plans rarely delegate HRA activities to external entities

BHealth plans typically focus their HRA efforts on newly enrolled members

CHRA focuses on clinical data for an entire population and does not include demographic information that might identify individual members

DHRA is generally a reliable predictor of medical resource utilization

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Correct Answer: B

Question No. 5

Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.

AThe proportion of adult members who are screened for hypertension will increase by ten percent.

BPrimary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.

CThe QM program director will evaluate the level of provider compliance with clinical practice guidelines (CPGs).

DThe disease management program director will increase participation by asthmatic children in the health plan's pediatric asthma disease management program.

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Correct Answer: B

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