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

Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say

A : that they are focused primarily on health maintenance organization (HMO) plans

B : that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS) 3.0

C : that they are used to rank the performance of various health plans

D : all of the above

Answer: D

Question 2

Examples of alternative healthcare practitioners are chiropractors, naturopaths, and acupuncturists. The only well-established credentialing standards for alternative healthcare practitioners are those available from NCQ A. These NCQA credentialing standards apply to

A : chiropractors

B : naturopaths

C : acupuncturists

D : all of the above

Answer: A

Question 3

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 4

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 5

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

Page: 1 / 33

Total 165 Questions | Updated On: Jan 04, 2026

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