Absolute Free AHM-540 Exam Practice for Comprehensive Preparation 

Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say  

Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of 

contract with pharmacy benefit managers (PBMs). Functions that a PBM typically performs for a

health plan include

1. Managing the costs of prescription drugs

2. Promoting efficient and safe drug use

3. Determining the health plan’s internal management responsibilities for pharmacy services

1. Case management incorporates activities that may fall outside a health plan’s typical

responsibilities, such as assessing a member’s financial situation

2. Case management generally requires a less comprehensive and complex approach to a course

of care than does utilization review

3. Case management is currently applicable only to medical conditions that require inpatient

hospital care and are categorized as catastrophic in terms of health and/or costs 

A health plan’s coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1. In case of conflict between the purchaser contract and a health plan’s medical policy or benefits administration policy, the contract takes precedence 2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3. All of the criteria for coverage decisions must be included in the purchaser contract