Get All AHM Medical Management Exam Questions with Validated Answers
| Vendor: | AHIP |
|---|---|
| Exam Code: | AHM-540 |
| Exam Name: | AHM Medical Management |
| Exam Questions: | 163 |
| Last Updated: | March 1, 2026 |
| Related Certifications: | Network Management |
| Exam Tags: | AHIP Management |
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The Brighton Health Plan regularly performs prospective UR for surgical procedures. Brighton's prospective UR activities are likely to include
To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction dat
a. The following statement(s) can correctly be made about the sources of clinical data:
Patient surveys are the most widely used source of disease-specific clinical information
Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers
The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status
Home healthcare encompasses a wide variety of medical, social, and support services delivered at the homes of patients who are disabled, chronically ill, or terminally ill. The time period(s) when health plans typically use home healthcare include
The period prior to a hospital admission
The period following discharge from a hospital
Patricia McLeod is a member of the Enterprise Health Plan, which operates in State X. Ms. McLeod is scheduled to undergo a unilateral mastectomy for the treatment of breast cancer. The surgical procedure will be performed by Dr. Kim Lee, a surgical oncologist. Based on Enterprise's medical policy, the contract with the purchaser, and Ms. McLeod's medical condition, Enterprise's UR staff have determined that the appropriate course of care for Ms.
McLeod includes a 24-hour stay in the hospital following her surgery. State X, however, has a benefit mandate specifying health plan coverage for 48 hours of inpatient post-mastectomy care. In this situation, the length of hospital stay for which Enterprise must offer coverage is
The following statement(s) can correctly be made about the hospitalist approach to inpatient care management:
Management of inpatient care by hospitalists may significantly reduce the length of stay and the total costs of care for a hospital admission
Most health plans that use hospitalists do so through a voluntary hospitalist program
A hospitalist's familiarity with utilization management (UM) and quality management (QM) standards for inpatient care may reduce unnecessary variations in care and improve clinical outcomes
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