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AHM-540 AHIP Medical Management Free Practice Exam Questions (2025 Updated)

Prepare effectively for your AHIP AHM-540 Medical Management certification with our extensive collection of free, high-quality practice questions. Each question is designed to mirror the actual exam format and objectives, complete with comprehensive answers and detailed explanations. Our materials are regularly updated for 2025, ensuring you have the most current resources to build confidence and succeed on your first attempt.

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Total 163 questions

The Carlyle Health Plan uses the following clinical outcome measures to evaluate its diabetes and asthma disease management programs:

Measure 1: The percentage of diabetic patients who receive foot exams from their providers according to the program’s recommended guidelines Measure 2: The number of asthma patients who visited emergency departments for acute asthma attacks

From the answer choices below, select the response that correctly identifies whether these measures are true outcome measures or intermediate outcome measures. Measure 1- Measure 2-

A.

Measure 1-true outcome measure Measure 2-true outcome measure

B.

Measure 1-true outcome measure Measure 2-intermediate outcome measure

C.

Measure 1-intermediate outcome measure Measure 2-true outcome measure

D.

Measure 1-intermediate outcome measure Measure 2-intermediate outcome measure

For this question, if answer choices (a) through (c) are all correct, select answer choice (d). Otherwise, select the one correct answer choice.

Well-crafted clinical practice guidelines (CPGs) can benefit healthcare delivery processes and outcomes by

A.

providing a framework for care while also allowing for patient-specific variations, based on physician judgment

B.

serving as a basis for evaluating whether providers are practicing in accordance with accepted standards

C.

focusing on the prevention or early detection of a particular condition

D.

all of the above

The Medicaid population can be divided into subgroups based on their relative size and the costs of providing benefits. From the answer choices below, select the response that correctly identifies the subgroups that represent the largest percentages of the total Medicaid population and of total Medicaid expenditures. Largest % of Medicaid Population- Largest % of Medicaid Expenditures-

A.

Largest % of Medicaid Population-dual eligibles Largest % of Medicaid Expenditures-children and low-income adults

B.

Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for MedicareLargest % of Medicaid Expenditures-dual eligibles

C.

Largest % of Medicaid Population-children and low-income adults Largest % of Medicaid Expenditures-chronically ill or disabled individuals not eligible for Medicare

D.

Largest % of Medicaid Population-chronically ill or disabled individuals not eligible for Medicare Largest % of Medicaid Expenditures-children and low-income adults

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

7. One method that health plans use to address provider compliance with formularies is academic detailing.

A.

True

B.

False

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

In most commercial health plans, the case management process is directed by a case manager whose responsibilities typically include

A.

focusing on a disabled member’s vocational rehabilitation and training

B.

approving all care decisions for patients under case management

C.

reducing the fragmentation of care that often results when individuals obtain services from several different providers

D.

all of the above

A health plan's preventive care initiatives may be classified into three main categories: primary prevention, secondary prevention, and tertiary prevention. Secondary prevention refers to activities designed to

A.

develop an appropriate treatment strategy for patients whose conditions require extensive, complex healthcare

B.

educate and motivate members to prevent illness through their lifestyle choices

C.

prevent the occurrence of illness or injury

D.

detect a medical condition in its early stages and prevent or at least delay disease progression and complications

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

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