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.
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.
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.
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.