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Exam Information
Official specifications published by AHIP
Exam Format
90 min
75
80%
Fellow
Registration
$220 USD
Online or online proctoring
Validity
Permanent (FAHM designation does not expire)
AHM-510 Exam Topics and Domains
AHM-510 is organized into 5 weighted domains. Expect to work with Compliance monitoring, Formulary management, Legal compliance, Quality reporting, and more.
1
Health Insurance Industry Structure and Formation
20%
Industry Evolution and Formation
Historical Development of Managed CareCurrent Market Trends and Forces
- Identify factors shaping the health insurance industry
- Understand the formation and evolution of managed care organizations
- Recognize current market trends affecting the industry
Types of Health Insurance Organizations
Health Maintenance Organizations (HMOs)Other Plan Types
- Differentiate between types of health insurance organizations
- Understand the structure and operational models of each plan type
- Identify key features and requirements for different plan types
Organizational Structures and Governance
Corporate Governance ModelsStrategic Planning and Reorganization
- Understand organizational control systems and governance structures
- Apply strategic planning methodologies
- Recognize reorganization and performance improvement strategies
2
Legal and Regulatory Environment
30%
ERISA Legal Issues
ERISA Preemption DoctrineFiduciary ResponsibilitiesClaims and Appeals Procedures
- Understand ERISA legal framework and requirements
- Identify fiduciary duties and prohibited transactions
- Apply claims and appeals procedures correctly
Pharmacy Benefits Legal Issues
Formulary Management and RegulationsPharmacy Network and Contracting
- Understand legal issues surrounding pharmacy benefits
- Apply formulary management regulations
- Navigate pharmacy network legal requirements
Wellness Program Regulations
ADA, GINA, and EEOC ComplianceHIPAA Wellness Program Rules
- Understand wellness program legal frameworks
- Apply ADA, GINA, and EEOC regulations
- Design compliant wellness incentive programs
Post-Reform Legal Environment
Affordable Care Act ComplianceMedical Loss Ratio and Network Adequacy
- Understand post-ACA legal requirements
- Calculate and report Medical Loss Ratio
- Ensure network adequacy compliance
Federal and State Regulatory Requirements
Federal Regulatory FrameworkState Regulatory Requirements
- Navigate federal regulatory requirements
- Understand state insurance regulation
- Coordinate federal and state compliance
3
Government Healthcare Programs
30%
Medicare Program Administration
Medicare Parts A and B (Original Medicare)Medicare Part C (Medicare Advantage)Medicare Part D (Prescription Drug Coverage)Medicare Supplement (Medigap)
- Understand Medicare program structure and coverage
- Navigate Medicare Advantage and Part D requirements
- Apply Medicare coordination of benefits rules
Medicaid Program Management
Medicaid Eligibility and CoverageMedicaid Managed CareDual Eligible Populations
- Understand Medicaid program structure and state variations
- Navigate Medicaid managed care requirements
- Coordinate services for dual eligible beneficiaries
Federal Government as Healthcare Purchaser
Federal Employees Health Benefits Program (FEHBP)TRICARE and Veterans Programs
- Understand federal employee health benefit programs
- Navigate TRICARE and VA program requirements
- Apply government contracting principles
Compliance and Fraud Prevention in Government Programs
Compliance Program ElementsFraud, Waste, and Abuse Programs
- Implement government program compliance requirements
- Detect and prevent fraud, waste, and abuse
- Manage audits and corrective actions
4
Healthcare Finance and Fraud Prevention
10%
Healthcare Finance Fundamentals
Revenue Cycle and Cost Accounting
- Understand healthcare finance fundamentals
- Apply cost accounting principles
- Manage revenue cycle effectively
Reimbursement and Payment Models
Traditional and Value-Based Payment Models
- Differentiate reimbursement methodologies
- Understand value-based payment structures
- Apply risk-sharing principles
Fraud and Abuse Impact
Healthcare Fraud Laws and RegulationsFraud Detection and PreventionCost and Quality Impact of Fraud
- Understand healthcare fraud laws
- Implement fraud detection programs
- Assess fraud impact on cost and quality
5
Organizational Control and Governance
10%
Internal Control and Accountability Systems
Control Frameworks and Risk ManagementExternal Accountability
- Implement internal control systems
- Manage organizational risks
- Meet external accountability demands
Performance Improvement and Quality Management
Quality Improvement MethodologiesPerformance Measurement Systems
- Apply quality improvement methodologies
- Develop performance measurement systems
- Drive continuous organizational improvement
Strategic Management and Change
Strategic Planning ProcessesOrganizational Change Management
- Develop and implement strategic plans
- Manage organizational change effectively
- Build high-performing organizational cultures
How do I earn this certification?
Passing AHM-510 earns the Fellow, Academy for Healthcare Management (FAHM®) certification. It sits in the Healthcare Management track.
Current Level Exams
- AHM-520 - Health Plan Finance and Risk Management
- AHM-530 - Network Management
- AHM-540 - Medical Management
Next Level Options
- Managed Healthcare Professional (MHP) Advanced certification for managed care professionals
- Certified Healthcare Reform Specialist (CHRS) Specialized certification in healthcare reform and compliance
Alternative Paths
- AHIP Medicare Training - Medicare + Fraud, Waste, and Abuse Training Specialized Medicare compliance for agents and brokers
- HITECH Certification Complementary technology and privacy skills
Practice with Precision
The PlanetCert Simulator mirrors the real exam environment with authentic questions and timed pressure.
How to study for this exam?
The most effective way to prepare for AHM-510 is by using the PlanetCert Simulator to practice questions and review detailed explanations.
What's changed on this exam?
Current Status
- ACTIVE
- Last content update: 2024-05-19
Updates
- Medicaid Managed Care IT Systems 2024 Final Rule Requirements Updates to technology requirements for Medicaid plans • Release date: 2024-05-01
- Medicare Star Ratings Analytics 2026 Methodology New quality measurement and reporting requirements • Release date: 2024-07-10
Who should take this exam?
This exam is typically taken by Health insurance agents and brokers and Case managers and medical directors.
- Minimum one year of experience in health insurance industry
- Completion of AHIP-approved health insurance training program (alternative)