Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Audience:

Hospitals and Other Providers
Business Partners
Physicians and Other Practitioners

Career level:

Experienced Professional
Early Careerist
Student

Recommended for:

Claims
Patient Access
Physician Practice
Reimbursement
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:

None

Prerequisites:

None

Course Availability:

18 Months

Fact Sheet | Payment, Reimbursement, and Managed Care
HFMA presents a comprehensive summary of the FY21 IPPS final rule, released by CMS.
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Fact Sheet | Payment, Reimbursement, and Managed Care
HFMA presents this overview of the CMS FY21 IPPS final rule.
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Fact Sheet | Payment, Reimbursement, and Managed Care
HFMA presents an executive summary highlighting the key provisions of the Quality Payment Program contained in the CY 2021 physician fee schedule proposed rule.
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Blog | Payment, Reimbursement, and Managed Care
HFMA's Katie Gilfillan says the E/M coding changes taking place January 1, 2021, will have significant impacts not only to primary care physicians but also will have significant impact on specialist’s reimbursement.
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Fact Sheet | Payment, Reimbursement, and Managed Care
HFMA presents a detailed summary of the CY 2021 physician fee schedule proposed rule.
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Course | Intermediate | Payment, Reimbursement, and Managed Care

Medicare and Medicaid Reimbursement Systems

Course | Intermediate | Payment, Reimbursement, and Managed Care

Medicare and Medicaid Reimbursement Systems

Description

This course describes the regulatory agencies that have authority over healthcare organizations, including the Centers for Medicare and Medicaid Services. It also explains how Medicare and Medicaid function as payers, and how different kinds of healthcare organizations are reimbursed for services to beneficiaries. The course explains the ways in which Medicare calculates the amount of reimbursement for services provided by physicians and hospitals as well as how payment rates are set for Medicare HMOs. This course also describes a hospital's responsibilities under the Emergency Medical Treatment and Active Labor Act (EMTALA).

Estimated course completion time: 1 hour
After this program, you'll be able to..
  • List and explain the purpose and activities of various healthcare regulatory agencies, including CMS, PRRB, FTC, Joint Commission, PRO, OIG, and USPHS
  • Recognize how the Public Health Service protects and advances the health of the nation
  • Recognize how the Joint Commission's survey program works
  • Differentiate Medicare from Medicaid
  • Recognize how parts A and B of the Medicare insurance plan are funded
  • Recognize the mechanics of Prospective Payment System (PPS) reimbursement and the services covered under the diagnosis related group (DRG) payment
  • Identify the four phases of the process that Medicare uses to determine cost reimbursement to providers
  • Recognize how ambulatory payment classification groups (APCs) are used in the outpatient prospective payment system (PPS)
  • State the reimbursement formula for physician services
  • Recognize the purpose and process of uncompensated care/S10 reporting
  • Recognize how the adjusted average per capita cost (AAPCC) is used to determine payment rates for Medicare enrollees in HMOs
  • State the four steps used to calculate AAPCC rates
  • Identify the provisions of the Emergency Medical Treatment and Active Labor Act (EMTALA)

Related Courses | Payment, Reimbursement, and Managed Care

On Demand Webinar | Update | Legal and Regulatory Compliance

How to accelerate financial results of a specialty pharmacy service

Prepare your organization now for the proposed CY21 changes to the ambulatory surgery center (ASC) payment system and the hospital outpatient payment system (OPPS) CY21. Find out what changes are proposed for implementation on January 1, 2021, for ASCs and hospital leaders will not want to keep a close watch on ASC and OPPS developments as more services migrate from one setting to another.

Topics include proposed 2021 changes to:

  • APC groupings
  • OPPS changes to drugs, biological, and radiopharmaceuticals
  • OPPS for packaging
  • Inpatient Only List
  • ASCs
  • Hospital outpatient and ASC quality requirements
  • Additional changes to other policy areas

On Demand Webinar | Intermediate | Revenue Cycle

Creating a work-from-home playbook

Even prior to COVID-19, many organizations began experimenting with work-from-home arrangements, especially in the revenue cycle space. In this session, you'll hear one organization's experience with employing a work-from-home committee to transform a system policy approach into one that worked for all aspects of the revenue cycle - back, middle and front end. In addition, you'll learn how they created metrics to monitor and measure productivity as well as establish quality monitoring.


Original Live Date: HFMA Digital Annual Conference (7/17/2020)

On Demand Webinar | Basic | Revenue Cycle

Engaging a Multigenerational Workforce with Gamification

In an increasingly tight labor market, patient account representative engagement is more important than ever, especially in light of increased patient experience expectations. Engaging patient account representatives is challenging yet critical for every provider. Learn how one organization tackled this challenge through a multi-generational approach to gamificiation that can improve productivity and staff focus on organizational and individual goals, as well as reduce turnover. Understanding the tendencies of each generation can assist in creating pathways for representative engagement.


Original Live Date: HFMA Digital Annual Conference (7/17/2020)

On Demand Webinar | Intermediate | Patient Experience

Diagnosis Financial Strain:One Organization's Approach to the Patient Financial Experience

This session will present an effective process for assessing physician financial performance from an operational and strategic standpoint. The speakers will share a defined process to manage physician financial performance, including how to use cost accounting concepts to establish and manage appropriate operating budget results as well as how to use ROI concepts to assess and monitor strategic benefits in comparison to subsidy loss levels.


Original Live Date: HFMA Digital Annual Conference (7/17/2020)