Exam Name: Governance and Regulation
Certification Provider: AHIP
Corresponding Certification: AHIP Certification
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Reference: https://www.ahip.org/course/governance-and-regulation-ahm-510/
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AHIP AHM-510 Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Legal and Regulatory Framework | - Key legal issues in post-healthcare reform environment - ERISA, pharmacy benefits, and wellness program regulations - Federal and state regulatory compliance requirements |
| Health Insurance Industry Environment and Structure | - Formation, types, and structure of health plans - Strategic planning, reorganization, and performance improvement - Factors shaping the health insurance industry |
| Government Healthcare Programs | - Medicare program structure and requirements - Medicaid program structure and requirements - Federal government role as purchaser of health benefits |
| Governance, Compliance, and Integrity | - Fraud, waste, and abuse prevention and detection - Organizational governance and internal control systems - Accountability and regulatory reporting standards |
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