Overview of the Governance and Regulation Exam
AHM-510 evaluates healthcare insurance professionals, compliance officers, and health plan administrators on the foundational regulatory frameworks governing the United States health insurance industry. Candidates must demonstrate technical competency in the application of the Patient Protection and Affordable Care Act, the Health Insurance Portability and Accountability Act, and Medicare Part D compliance standards. The curriculum emphasizes the governance of private health plan operations, risk adjustment methodologies, and federal oversight protocols established by the Centers for Medicare and Medicaid Services. Proficiency requires mastery of statutory requirements for market conduct, consumer protection, and the systemic management of regulatory reporting within managed care organizations.