Free AHIP AHM-540 Exam Questions

Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of 

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

Health plans that choose to contract with external organizations for pharmacy services typicallycontract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for ahealth plan include1. Managing the costs of prescription drugs2. Promoting efficient and safe drug use3. Determining the health plan’s internal management responsibilities for pharmacy services

Health plans arrange for the delivery of various levels of healthcare, including1. Emergency care2. Urgent care3. Primary care delivered in a provider’s officeIn a ranking of these levels of care according to cost, beginning with the least expensive level ofcare and ending with the most expensive level of care, the correct order would be 

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