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

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

Question 3

One true statement about state regulation of case management activities is that the majority of states

A : have enacted laws that list specific quality management requirements for a case management program

B : consider case management files to be medical records that must be retained for a specified length of time

C : view case management similarly and follow similar patterns with their laws and regulations

D : have enacted laws or regulations requiring licensure or certification of case managers

Answer: B

Question 4

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

Question 5

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

A : standard medical-surgical services

B : mental health and substance abuse services

C : services offered to Medicare enrollees as optional supplementary benefits

D : all of the above

Answer: D