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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:

SectionObjectives
Compliance and Legal Requirements- Legal and ethical obligations
  • 1. Consumer protection requirements
    • 2. Ethical standards in insurance operations
      - Compliance programs
      • 1. Fraud, waste, and abuse prevention
        • 2. Internal compliance monitoring
          Regulatory Environment in Health Insurance- Federal regulation
          • 1. HIPAA privacy and security rules
            • 2. ERISA regulations
              • 3. Affordable Care Act (ACA) requirements
                - State regulation
                • 1. State insurance commissioners and oversight
                  • 2. State benefit mandates
                    Health Insurance Governance Framework- Corporate governance structures
                    • 1. Risk management governance
                      • 2. Organizational governance models
                        - Roles and responsibilities of governing bodies
                        • 1. Board oversight and fiduciary duties
                          • 2. Executive management accountability

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