Cost:

Free for HFMA Members
$399 for Non-members

Audience:

Health Plans
Hospitals and Other Providers
Physicians and Other Practitioners

Career level:

Experienced Professional
Mid-Senior

Recommended for:

Healthcare Economics
Managed Care
Payer Contracting
Physician Practice
Revenue Cycle
Billing

Delivery Method:

QAS Self Study

Advance Preparation:

None

Field of Study:

Finance: 2.0 hours
Specialized Knowledge: 10.0 hours

Prerequisites:

None

Course Availability:

18 Months

Blog | Managed Care
Health plans seeking state legislative help with site-neutral payments will likely find allies among employers who are increasingly frustrated with healthcare costs.
Save
Blog | Managed Care
Employer frustration with high healthcare costs is translating into support for more aggressive governmental intervention in healthcare markets.
Save
Blog | Managed Care
Hospitals and health systems need to be able to deliver high-quality outcomes in a cost-efficient manner to ensure they are not implicitly tiered out of a health plan's network.
Save
Blog | Managed Care
New survey results: Those that favor Medicare for All are more dissatisfied with the cost of healthcare and concerned about paying for care if they became ill.
Save
Blog | Managed Care
Hospital finances could be significantly impacted by UnitedHealthcare’s expansion of site-of-service prior authorization requirements going into effect Nov. 1.
Save
Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)

Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)

Description

Get recognized as a valued contributor to your organization's financial performance when you earn HFMA's Certified Specialist Managed Care (CSMC) certification.

Those who earn this certification have demonstrated specialist-level knowledge of models, payment rates, benefit coordination, reimbursement, cost-control incentives, legislative changes, and more.

Available online, 24/7, this certification, online program, certification maintenance, and digital badging related costs are all included in HFMA membership.

Course Outline:
Overview of Managed Care
Healthcare Delivery Systems
Managed Care Reimbursement Methodologies
Managed Care: Incentives, Emerging Trends, and Risks
Provider and Payer Infrastructure and Process
Managed Care Contracting and Negotiating
Managed Care: Trends in Case and Utilization Management
Healthcare Industry Regulation and Accreditation
Trends in Healthcare Policy
Essentials of Medicare and Medicaid Managed Care

Assessment information:
The online program includes the course modules listed above and a certification assessment. The assessment has 75 multiple choice questions and you have 90 minutes to complete it in one sitting. The passing score is 70%. If you do not pass the assessment on the first attempt, there is a mandatory waiting period. You'll have access to the exam summary and the course while you wait for your next attempt. The exam summary will show you how you did on the questions from each course module of the online program.

Estimated course completion time: 10-12 hours

If you need to recertify, please click here.

Note: If you are an HFMA member and currently registered for this program and need additional time because it is expired or expiring soon, please email elearning@hfma.org to request an extension.
After this program, you'll be able to..
  • Identify key factors that influenced the development of managed care
  • Explain coordination of benefits, managed Medicare organizations, and TRICARE
  • Identify the clinical integration components of case management
  • List the two main issues to consider when discussing the safe use of EHRs
  • Discuss the potential results of EHR's emphasis in providing one standardized clinical data structure and presentation
Online program last updated: 5/24/2018

Related Courses | Managed Care

Certification | Overview | Revenue Cycle

Certified Revenue Cycle Representative Recertification

The CRCR recertification program is recommended for active, eligible, HFMA CRCR certificants with an upcoming maintainance due date of May 31, 2020. Not sure when your CRCR expiration date is? Sign in, click your profile image in the upper right corner, select My Development, and then click on the Certifications tab near the center of the page. You'll see your certifications along with their expiration date. 


HFMA requires that eligible CRCR certificants gain continuing competence in the revenue cycle arena by taking a short assessment every two years.  The program provides healthcare organizations with a means to ensure that their revenue cycle staff has the body of knowledge necessary to meet their demands. 

Click here to see the list of specific topics covered in this year's recertification course. 

Assessment information:
This online program includes the recertification course and a recertification assessment. The assessment has 50 multiple choice questions and you have 90 minutes to complete it in one sitting. The passing score is 70%. If you do not pass on the first attempt, there is a mandatory 30-day waiting period. Please keep this in mind, as the deadline to complete the recertification assessment (to maintain your certification) is May 31, 2020.


Course | Basic | Patient Access

Importance of Insurance Verification

In this course we highlight the various types of health insurance that your patients may present at registration. We'll review the fundamentals of Medicare, Medicaid, and third-party liability plans. You'll learn how verifying a patient's insurance eligibility and benefits affect the coordination of benefits process, which determines the primary payer and secondary payer on a claim.


Estimated course completion data: 30 minutes

Certification | Overview | Managed Care

Certified Specialist Managed Care Recertification

The CSMC recertification program is recommended for active, eligible, HFMA CSPPM certificants with an upcoming maintenance due date of May 31, 2020. Not sure when your CSMC expiration date is? Sign in, click your profile image in the upper right corner, select My Development, and then click on the Certifications tab near the center of your page. You'll see your certifications along with their expiration date.

HFMA requires that eligible CSMC certificants gain continuing competence in the managed care arena by taking a short assessment every two years. This program provides healthcare organizations with a means to ensure that their staff has the body of knowledge necessary to meet their demands.

CSMC recertification course outline:

  • Healthcare Delivery Systems
  • Managed Care Reimbursement Methodologies
  • Managed Care: Incentives, Emerging Trends, and Risks
  • Provider and Payer Infrastructure and Process
  • Essentials of Medicare and Medicaid Managed Care
Assessment Information:
This online program includes the above recertification courses and a recertification assessment. The assessment has 50 multiple choice questions and you have 90 minutes to complete it in one sitting. The passing score is 70%. If you do not pass on the first attempt, there is a mandatory 30-day waiting period. Please keep this in mind, as the deadline to complete the recertification assessment (to maintain your certification) is May 31, 2020.

Certification | Overview | Accounting and Financial Reporting

Certified Specialist Accounting & Finance Recertification

The CSAF recertification program is recommended for active, eligible HFMA CSAF certificants with an upcoming maintenance due date of May 31, 2020. Not sure when your CSAF expiration date is? Sign in, click your profile image in the upper right corner, select My Development, and then click on the Certifications tab near the center of the page. You'll see your certifications along with their expiration date.


HFMA requires that eligible CSAF certificants gain continuing competence in the accounting and finance arena by taking a short assessment every two years. This program provides healthcare organizations with a means to ensure that their staff has the body of knowledge necessary to meet their demands. 

CSAF recertification course outline:
  • Financial Planning and Budgeting
  • Financial Reporting: Liabilities and Long-Term Debt
  • Financial Reporting: Relationships and Procedures
  • Financial Reporting: Revenue and Assets
  • Accounting Oversight and Internal Control
Assessment information:
This online program includes the above recertification courses and a recertification assessment. The assessment has 50 multiple choice questions and you have 90 minutes to complete it in one sitting. The passing score is 70%. If you do not pass on the first attempt, there is a mandatory 30-day waiting period. Please keep this in mind, as the deadline to complete the recertification assessment (to maintain your certification) is May 31, 2020.