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AHIP AHM-520 real answers - Health Plan Finance and Risk Management

AHM-520
  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Updated: Sep 01, 2026
  • Q & A: 215 Questions and Answers
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Reference: https://www.ahip.org/courses/health-plan-finance-and-risk-management-ahm520

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AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Topic 1: Health Plan Financial Fundamentals- Cost accounting in health plans
  • 1. Medical cost classification
    • 2. Administrative vs medical expense allocation
      - Health insurance revenue streams and premium structures
      • 1. Membership and enrollment impact on revenue
        • 2. Premium development basics
          Topic 2: Risk Management in Health Plans- Insurance risk concepts
          • 1. Underwriting principles in managed care
            • 2. Risk pooling and transfer mechanisms
              - Utilization and cost control strategies
              • 1. Provider reimbursement models (capitation, FFS, bundled payments)
                • 2. Managed care cost containment tools
                  Topic 3: Health Plan Payment and Reimbursement Systems- Value-based payment models
                  • 1. Shared savings models
                    • 2. Pay-for-performance programs
                      - Provider payment methodologies
                      • 1. Capitation and risk adjustment basics
                        • 2. Fee-for-service reimbursement

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