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AHIP AHM-540 Practice Test Questions Answers

Exam Code: AHM-540 (Updated 163 Q&As)
Exam Name: Medical Management
Last Update: 17-Sep-2025
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  • Single Choice: 163 Q&A's

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    AHM-540 Questions and Answers

    Question # 1

    Step-therapy is a form of prior authorization that reserves the use of more expensive medications for cases in which the use of less expensive medications has been unsuccessful. Step-therapy is appropriate for situations in which

    1. A significant percentage of those treated with the initial therapy will require the second therapy

    2. The delay created when a patient moves from one therapy to the next therapy will not cause serious or permanent effects

    A.

    Both 1 and 2

    B.

    1 only

    C.

    2 only

    D.

    Neither 1 nor 2

    Question # 2

    To see that utilization guidelines are consistently applied, UR programs rely on authorization systems. Determine whether the following statement about authorization systems is true or false:

    Only physicians can make nonauthorization decisions based on medical necessity.

    A.

    True

    B.

    False

    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

    Question # 4

    Recent laws and regulations have established new requirements for Medicaid eligibility. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 affected Medicaid eligibility by

    A.

    severing the link between Medicaid and public assistance

    B.

    eliminating the need for applications for Medicaid and public assistance

    C.

    allowing states to provide healthcare benefits to groups outside the traditional Medicaid population

    D.

    providing supplemental funding for dual eligibles in the form of five-year block grants

    Question # 5

    Among this agency’s accreditation programs are accreditation for preferred provider organizations (PPOs), health plan call centers, and case management organizations. This agency classifies its standards as either “shall” standards or “should” standards.

    A.

    American Accreditation HealthCare Commission/URAC (URAC)

    B.

    Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    C.

    Community Health Accreditation Program (CHAP)

    D.

    National Committee for Quality Assurance (NCQA)

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