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Hospitals and Other Providers
Physicians and Other Practitioners

Career level:

Experienced Professional

Recommended for:

Managed Care
Payer Contracting
Physician Practice
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:




Course Availability:

18 Months

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.
Trend | Contracting
A short description of payment methodologies offers context on the argument about whether fixed fees are preferable to percent-of-charge provisions.
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.
News | Contracting
How one health system won a large direct contract as such arrangements become more widespread.
How To | Contracting
Various circumstances require providers to prepare for the impact of payment changes.
Course | Advanced | Contracting

Contract Management

Course | Advanced | Contracting

Contract Management


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

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 | 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

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 | Intermediate | Contracting

Managed Care Contracting and Negotiating

This course discusses criteria to use in evaluating the written contract between the provider and managed care organization, which defines the rights and obligations of the parties under the health plan/provider relationship. It also defines key contract terminology, provisions, and clauses and describes reimbursement levels and methodologies. It highlights general issues that commonly arise during the contract negotiation process and describes common negotiation strategies. It defines direct contracting and third-party contracting and points out the differences between them.

Estimated course completion time: 1 hour