Free AHM-540: Medical Management Exam Questions and Answers
81 verified practice questions for AHM-540.
The first 10 questions on this page are free to read, answers included — no account and no card. A plan opens the rest of the bank, the full timed practice test and your weak-topic reporting.
Last updated: September 19, 2026
- Exam code
- AHM-540
- Provider
- AHIP
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- First 10, with answers
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Question #1
Health plans that offer complementary and alternative medicine (CAM) services face potential liability because many types of CAM services
Please select an optionIncorrectCorrect answer: B
Many CAM therapies lack rigorous clinical trials establishing safety and effectiveness, exposing plans to liability if they cover them. CAM services are often holistic rather than symptom-focused and can be integrated into standard benefits.
Was this answer correct?Question #2
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-
Please select an optionIncorrectCorrect answer: C
Children and low-income adults make up the largest share of Medicaid enrollees but are inexpensive to cover, while chronically ill and disabled beneficiaries not eligible for Medicare account for the largest share of spending.
Was this answer correct?Question #3
Breanna Osborn is a case manager for a regional health plan. One component of Ms. Osborn’s job is the collection and evaluation of medical, financial, social, and psychosocial information about a member’s situation. This component of Ms. Osborn’s job is known as
Please select an optionIncorrectCorrect answer: D
Gathering and evaluating medical, financial, social, and psychosocial information about a member's situation is case assessment, which precedes planning and coordination of care.
Was this answer correct?Question #4
The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph. Definitions of quality healthcare vary; however, four dimensions are essential to quality healthcare services. _____ is the quality dimension indicating that services result in the best care for a given cost or the lowest cost for a given level of care.
Please select an optionIncorrectCorrect answer: D
Efficiency is the quality dimension that relates the level of care to its cost: best care for a given cost or lowest cost for a given level of care.
Was this answer correct?Question #5
The following statement(s) can correctly be made about the characteristics of peer review: * 1.Peer review is applicable to either single episodes of care or to entire programs of care * 2.Most peer review is conducted concurrently * 3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
Please select an optionIncorrectCorrect answer: C
Peer review can address single cases or whole programs, and HCQIP requires peer review for Medicare and Medicaid managed care services. Most peer review is retrospective, not concurrent, so statement 2 is false.
Was this answer correct?Question #6
The following statements are about health plans’ development of medical policies. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
Please select an optionIncorrectCorrect answer: A
Technology assessment applies to existing technologies and new uses of them, not only to new procedures, drugs, and devices, so statement A is false. The other statements accurately describe medical policy development.
Was this answer correct?Question #7
This agency oversees the Federal Employee Health Benefits Program (FEHBP).
Please select an optionIncorrectCorrect answer: B
The Office of Personnel Management administers the Federal Employees Health Benefits Program and contracts with participating health plans.
Was this answer correct?Question #8
Health plan performance measures include structure measures, process measures, and outcome measures. The following statements are about the characteristics of these three types of performance measures. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
Please select an optionIncorrectCorrect answer: B
Structure measures are the least directly linked to outcomes; process measures relate more closely to results, so B is false. The other statements correctly describe structure, process, and outcome measures.
Was this answer correct?Question #9
The following statements are about the characteristics of a utilization review (UR) program. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
Please select an optionIncorrectCorrect answer: C
UR determines whether proposed services are medically necessary and covered, but it does not dictate which procedures providers should perform, so C is false.
Was this answer correct?Question #10
Determine whether the following statement is true or false: Participation in disease management programs is currently voluntary.
Please select an optionIncorrectCorrect answer: A
Disease management program participation is currently voluntary; members may decline or opt out, so the statement is true.
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