Free AHIP AHM-540 Exam Questions

Question 1

Michelle Durden, who is enrolled in a dental health maintenance organizations (DHMO) offered by her employer, is due for a routine dental examination. If the plan is typical of most DHMOs, then Ms. Durden

A : must pay the entire cost of the examination

B : must obtain a referral to a dentist from her primary care provider (PCP)

C : can schedule the examination without preauthorization of payment by the DHMO

D : can schedule an unlimited number of examinations and cleanings per year

Answer: C

Question 2

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.

A : Internal / internal

B : Internal / external

C : External / internal

D : External / external

Answer: D

Question 3

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.

A : Internal / internal

B : Internal / external

C : External / internal

D : External / external

Answer: D

Question 4

Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the

A : degree to which the progression of a disease or condition is understood

B : prevalence or rate of a sickness or injury within a given population

C : degree of severity of a particular disease or condition

D : presence of a chronic condition or added complication other than the condition that requires medical treatment

Answer: D

Question 5

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

A : provide only those benefits covered by Medicare Part A and Part B

B : are not subject to federal or state regulation

C : place primary care at the center of the delivery system

D : are structured as indemnity plans

Answer: C