Free AHIP AHM-540 Exam Questions

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

Helena Ray, a member of the Harbrace Health Plan, suffers from migraine headaches. To treatMs. Ray’s condition, her physician has prescribed Upzil, a medication that has Food and DrugAdministration (FDA) approval only for the treatment of depression. Upzil has not been tested forsafety or effectiveness in the treatment of migraine headache. Although Harbrace’s medical policyfor migraine headache does not include coverage of Upzil, Harbrace has agreed to provide extracontractualcoverage of Upzil for Ms. Ray.In this situation, the prescribing of Upzil for Ms. Ray’s headaches is an example of 

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 

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 

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