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Reference: https://www.ahip.org/course/governance-and-regulation-ahm-510/
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Governance and Regulation AHM-510 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-510 Exam validates candidate has the knowledge of types, and structure of health management organizations. This exam also verifies the candidate has a strong understanding of the role of healthcare administration in government-sponsored programs, such as Medicare and Medicaid. Candidates also know about the overall purpose and direction of healthcare management, the impact of fraud and abuse, and the role of public policy. In addition, the Candidate must have the ability to handle legal issues related to ERISA, pharmacy benefits, and wellness programs.
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| Section | Objectives |
|---|---|
| Topic 1: Health Insurance Industry Environment and Structure | - Strategic planning, reorganization, and performance improvement - Formation, types, and structure of health plans - Factors shaping the health insurance industry |
| Topic 2: Governance, Compliance, and Integrity | - Organizational governance and internal control systems - Accountability and regulatory reporting standards - Fraud, waste, and abuse prevention and detection |
| Topic 3: Government Healthcare Programs | - Federal government role as purchaser of health benefits - Medicaid program structure and requirements - Medicare program structure and requirements |
| Topic 4: Legal and Regulatory Framework | - ERISA, pharmacy benefits, and wellness program regulations - Key legal issues in post-healthcare reform environment - Federal and state regulatory compliance requirements |
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