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Reference: https://www.ahip.org/courses/healthcare-management-an-introduction-ahm250
Healthcare Management: An Introduction AHM-250 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-250 Exam validates candidates have the knowledge to survey of health insurance plans, their fundamentals, philosophy, and terminology. This exam also verifies the candidates have a strong understanding of the types of health insurance plans, their products, major operational areas of health plans, the impact of legislation, regulation on health plan and have deep knowledge of ethical problems affecting the health plan industry.
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| Section | Weight | Objectives |
|---|---|---|
| Health Plan Operations | 20% | - Claims administration and processing - Underwriting and rating principles - Information technology and health plan systems |
| Health Plan Organizations and Models | 20% | - HMO, PPO, POS, and managed indemnity plans - Consumer-directed plans: HSAs, HRAs, FSAs - Structure and types of health insurance providers |
| Provider Network Management | 15% | - Provider compensation models - Quality and performance measurement - Network design and contracting |
| Evolution of US Healthcare Delivery and Financing | 15% | - From prepaid plans to accountable care organizations (ACOs) - Historical development of health insurance |
| Regulatory Compliance and Ethics | 15% | - Legislative updates including 21st Century Cures Act - Federal and state regulations - Ethical standards and industry conduct |
| Government Healthcare Programs | 15% | - Affordable Care Act and regulatory impact - Medicaid and CHIP programs - Medicare program structure and coverage |
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