Free AHIP AHM-540 Exam Questions

Become AHIP Certified with updated AHM-540 exam questions and correct answers

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Total 165 Questions | Updated On: Jan 04, 2026

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Question 1

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

A : All of the above

B : 1 and 2 only

C : 2 and 3 only

D : 1 only

Answer: B

Question 2

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 3

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

A : case management

B : geriatric evaluation and management (GEM)

C : intervention identification

D : interdisciplinary home care (IHC)

Answer: C

Question 4

Benchmarking is a quality improvement strategy used by some health plans. With regard to benchmarking, it is correct to say that

A : cost-based benchmarking reveals why some areas of a health plan perform better or worse than comparable areas of other organizations

B : diagnosis-related groups (DRGs) are a source of benchmarking data that describe individual procedures and cover both inpatient and outpatient care

C : patient billing records provide a much more accurate account of procedure costs for benchmarking than do current procedural terminology (CPT) codes

D : the focus of benchmarking for health plan has shifted from identifying the lowest cost practices to identifying best practices

Answer: D

Question 5