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AHIP AHM-540 Exam Dumps

AHIP AHM-540 Exam Dumps

Certification Exams

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Number Of Questions: 163

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Exam Details

Exam Name:

Medical Management

Exam Code:

AHM-540

Total Questions in Exam:

163

Demo Questions

Q1. Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the

A.lack of qualified providers in provider networks

B. lack of resources necessary to establish case management programs for patients with complex conditions

C. unstable eligibility status of Medicaid recipients

D. inability of Medicaid recipients to change health plans or PCPs

Correct Answer: C

Q2. The following statement(s) can correctly be made about medical management considerations for the Federal Employee Health Benefits Program (FEHBP): FEHBP plan members who have exhausted the health plan's usual appeals process for a disputed decision can request an independent review by the Office of Personnel Management (OPM) All health plans that cover federal employees are required to develop and implement patient safety initiatives

A.Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

Correct Answer: A

Q3. The Mental Health Parity Act (MHPA) of 1996 is a federal law that establishes requirements for behavioral healthcare coverage for group plan members. The MHPA

A.requires health plans to offer mental health benefits to all eligible members

B. prohibits health plans that offer mental health benefits from imposing lower annual or lifetime dollar limits on mental illnesses than they do on physical illnesses

C. provides an exemption for health plans that can demonstrate cost savings of more than 1 percent

D. prohibits health plans from limiting the number of outpatient visits or inpatient days covered under the plan

Correct Answer: B

Q4. Adele Stanley, a member of the Greenhouse Health Plan, recently went to a network pharmacy to have a prescription filled. The pharmacist informed Ms. Stanley that the prescribed drug was not in the plan formulary and that reimbursement for the drug was not available except in extraordinary circumstances. The pharmacist asked Ms. Stanley if she would accept a generic substitute. If Ms. Stanley agrees to the generic substitution, she will receive a drug that

A.has not been tested for safety and efficacy in large clinical trials B. is available without a prescription at a reasonable cost

B. has been classified by the Food and Drug Administration (FDA) as safe, but that has not been proven fully effective

C. contains active ingredients that are identical to those of the prescribed brand-name drug

Correct Answer: D

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