Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Audience:

Hospitals and Other Providers
Physicians and Other Practitioners

Career level:

Experienced Professional
Mid-Senior

Recommended for:

Managed Care
Payer Contracting
Claims
Physician Practice
Reimbursement
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:

None

Prerequisites:

None

Course Availability:

18 Months

Blog | Contracting
Responses to the Business Group on Health's annual survey of its large employer members suggest employers are tired of waiting for providers and plans to figure out how to reduce healthcare cost.
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On Demand Webinar | Intermediate | Contracting
A medical center CEO will explain his role in facilitating contracting collaboration with medical staff, health plans, and with legal council for effective and efficient implementation in executing contracts. Learn about successful tools, s...
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Case Study | Contracting
Previous success in risk-based contracts will allow Atrius Health to thrive in its new global-risk arrangement with Blue Cross Blue Shield of Massachusetts, two of the provider’s leaders write.
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Trend | Contracting
A short description of payment methodologies offers context on the argument about whether fixed fees are preferable to percent-of-charge provisions.
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Trend | Contracting
Removing percent-of-charge provisions in favor of fixed fees would not remove the factors that drive price increases, nor would it reduce administrative hassles or decrease risk.
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Course | Advanced | Contracting

Contract Management

Course | Advanced | Contracting

Contract Management

Description

This course provides an introduction to managed care contracting. The purpose of a contract and its key components are described. The course explains criteria-based contracting. In addition, it describes elements to monitor to ensure contract compliance.

Estimated course completion time: 1 hour and 30 minutes
After this program, you'll be able to..
  • Identify the purpose of a contract
  • Identify key components and common terms of a contract
  • Identify key components and common terms of a health plan/payer contract
  • Define criteria-based contracting and recognize an evaluation model
  • Identify elements to monitor for contract compliance during the contract term, at renewal, or when problems arise with the current contractor

Related Courses | Contracting

On Demand Webinar | Intermediate | Contracting

Understanding the Semantics and Execution in Contract Negotiations

A medical center CEO will explain his role in facilitating contracting collaboration with medical staff, health plans, and with legal council for effective and efficient implementation in executing contracts. Learn about successful tools, strategies, and case studies for negotiating terms and identifying opportunities in health plan agreements and physician contracts.

Course | Overview | Health Plan Payment and Reimbursement

Health Plans - An Overview

In this course we will address the basic billing rules for major health plans, including an overview of basic billing features and benefits, types of billing rules and minor claim payers and plans.


Estimated course completion time: 30 minutes

Course | Overview | Managed Care

Overview of Managed Care

This course provides an overview of the state of managed care today and discusses how and why it has evolved. It also identifies major initiatives that are currently affecting managed care and will continue to do so in the future, as the U.S. continues to implement the reforms associated with the passage of the Patient Protection and Accountable Care Act (ACA) in March 2010. The course offers a solid foundation of knowledge that will provide necessary context for the more detailed information presented in subsequent courses in this series.


Estimated course completion time: 45 minutes

Course | Advanced | hfma:content/topic/physician_paymentandreimbursement

Physician Practice Management Coding and Payment Systems

This course discusses coding and payment systems, which establish the potential revenue of the physician practice. Other topics include fee schedules and relative value systems as well as compliance and rules for teaching physicians.


Estimated course completion time: 1 hour