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  • Total Questions: 215
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Who should take the AHM-520 exam

  • Agents and brokers who expert in life and health insurance
  • Employees who work for health care providers or health insurance plans and want to get the educational background to proceed with a management position in the industry
  • Financial executives working with clients looking to maximize their health dollars
  • Medical management employees working in hospitals, health systems, and, health insurance plans
  • Teachers at the school level who teach health care administration
  • Case administrators and medical directors who inquire a broader administrative background

Reference: https://www.ahip.org/courses/health-plan-finance-and-risk-management-ahm520

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What is the duration of the AHM-520 Exam

  • Format: Multiple choices, multiple answers
  • Number of Questions: 215
  • Length of Examination: 90 minutes

AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Topic 1: Regulatory and Compliance Framework- Governance and reporting
  • 1. Regulatory reporting
    • 2. Compliance oversight
      - Healthcare regulations
      • 1. Affordable Care Act requirements
        • 2. State insurance regulations
          Topic 2: Actuarial Principles and Forecasting- Actuarial concepts
          • 1. Cost projection
            • 2. Reserve estimation
              - Forecasting methods
              • 1. Financial planning
                • 2. Scenario modeling
                  Topic 3: Claims Analysis and Utilization Management- Claims data analysis
                  • 1. Trend analysis
                    • 2. Cost drivers
                      - Utilization management
                      • 1. Efficiency improvement
                        • 2. Cost containment strategies
                          Topic 4: Provider Payment Models- Traditional and alternative reimbursement
                          • 1. Fee-for-service
                            • 2. Capitation
                              - Value-based payment
                              • 1. Shared savings arrangements
                                • 2. Financial incentives and provider risk
                                  Topic 5: Risk Assessment and Risk Management- Risk mitigation strategies
                                  • 1. Risk adjustment
                                    • 2. Predictive modeling
                                      - Risk identification and evaluation
                                      • 1. Operational and financial risk
                                        • 2. Insurance risk
                                          Topic 6: Medical Loss Ratio and Compliance- Compliance requirements
                                          • 1. Reporting obligations
                                            • 2. Rebate requirements
                                              - Medical Loss Ratio concepts
                                              • 1. Regulatory thresholds
                                                • 2. MLR calculation
                                                  Topic 7: Health Plan Financial Structures- Revenue sources and premium development
                                                  • 1. Administrative and medical cost allocation
                                                    • 2. Premium setting principles
                                                      - Financial reporting
                                                      • 1. Financial statements
                                                        • 2. Performance measurement

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