Free AHIP AHM-530 Exam Questions

Become AHIP Certified with updated AHM-530 exam questions and correct answers

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Total 205 Questions | Updated On: Dec 18, 2025

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Question 1

The provider contract that Dr. Laura Cartier has with the Sailboat health plan includes a section known as the recitals. Dr. Cartier's contract includes the following statements:

A : A statement that identifies the purpose of the contract

B : A statement that defines in legal terms the parties to the contract

C : A statement that identifies the Sailboat products to be covered by the contract Of these statements, the ones that are likely to be included in the recitals section of Dr. Cartier's contract are statements:

D : A, B, and C

E : A and B only

F : A and C only

G : B and C only

Answer: A

Question 2

Medicaid beneficiaries pose a challenge for health plans attempting to establish Medicaid provider networks. Compared to membership in commercial health plans, Medicaid enrollees typically

A : Require access to greater numbers of obstetricians and pediatricians

B : Have stronger relationships with primary care providers

C : Are less reliant on emergency rooms as a source of first-line care

D : Need fewer support and ancillary services

Answer: A

Question 3

The following statement(s) can correctly be made about hospitalists.1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure thatthe patient receives appropriate care while in the hospital.2. The hospitalist’s role clearly supports the health plan concept of disease management.

A : Both 1 and 2

B : 1 only

C : 2 only

D : Neither 1 nor 2

Answer: B

Question 4

Medicaid beneficiaries pose a challenge for health plans attempting to establish Medicaid provider networks. Compared to membership in commercial health plans, Medicaid enrollees typically

A : Require access to greater numbers of obstetricians and pediatricians

B : Have stronger relationships with primary care providers

C : Are less reliant on emergency rooms as a source of first-line care

D : Need fewer support and ancillary services

Answer: A

Question 5

The following statements are about fee-for-service (FFS) payment systems. Select the answer choice containing the correct statement:

A : A discounted fee-for-service (DFFS) system is usually easier for a health plan to administer than is a fee schedule system.

B : A case rate payment system offers providers an incentive to take an active role in managing cost and utilization.

C : One reason that health plans use a relative value scale (RVS) payment system is that RVS values for cognitive services have traditionally been higher than the values for procedural services.

D : One reason that health plans use a resource-based relative value scale (RBRVS) is that this system includes weighted unit values for all types of procedures.

Answer: B

Page: 1 / 41

Total 205 Questions | Updated On: Dec 18, 2025

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