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Health Plan Finance and Risk Management AHM-520 Exam

Health Plan Finance and Risk Management AHM-520 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-520 Exam validates candidate has the ability to get a comprehensive look at the Health Insurance Plan Fund. This exam also verifies the candidate has a strong understanding of financial management techniques, funds, risk management, provider payment, project risk, pricing, care, and rating methods.

How much AHM-520 Exam Cost

The price of the AHM-510 exam is 220 USD for AHIP members and 280 USD for non-members.

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

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AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Claims Analysis and Utilization Management- Utilization management
  • 1. Cost containment strategies
    • 2. Efficiency improvement
      - Claims data analysis
      • 1. Cost drivers
        • 2. Trend analysis
          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
                  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
                          Actuarial Principles and Forecasting- Forecasting methods
                          • 1. Financial planning
                            • 2. Scenario modeling
                              - Actuarial concepts
                              • 1. Reserve estimation
                                • 2. Cost projection
                                  Medical Loss Ratio and Compliance- Medical Loss Ratio concepts
                                  • 1. Regulatory thresholds
                                    • 2. MLR calculation
                                      - Compliance requirements
                                      • 1. Rebate requirements
                                        • 2. Reporting obligations
                                          Regulatory and Compliance Framework- Governance and reporting
                                          • 1. Compliance oversight
                                            • 2. Regulatory reporting
                                              - Healthcare regulations
                                              • 1. State insurance regulations
                                                • 2. Affordable Care Act requirements
                                                  Risk Assessment and Risk Management- Risk mitigation strategies
                                                  • 1. Predictive modeling
                                                    • 2. Risk adjustment
                                                      - Risk identification and evaluation
                                                      • 1. Operational and financial risk
                                                        • 2. Insurance risk

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