Free for HFMA Members
$399 for Non-members

Delivery Method:

QAS Self Study

Course Availability:

12 Months

Recommended for:

Healthcare Economics
Managed Care
Payer Contracting
Physician Practice
Revenue Cycle

Career level:

Experienced Professional


Physicians and Other Practitioners
Hospitals and Other Providers
Health Plans

Field of Study:

Finance: 2.0 hours
Specialized Knowledge: 10.0 hours

Advance Preparation:



Q&A | Managed Care

Healthcare organizations engaging in value-based contracts may be at greater risk for a breach if patient privacy and HIPAA are not front and center.

Blog | Managed Care

Technological innovations can help healthcare organizations improve their managed care programs.

News | Managed Care

Most plans expected to enter the Medicare Advantage (MA) market over the next two years will be provider-sponsored, according to a health plan adviser.

Q&A | Managed Care

Is there a best practice for handling provider level adjustments (PLBs) in electronic health record (EHR) systems?

News | Managed Care

Oct. 23—A so-called mega rule to overhaul federal standards for Medicaid health plans could come days after the midterm election, an industry leader said this week.

Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)

Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)


This online program describes the nuts and bolts of managed care and thoroughly covers the issues surrounding healthcare reform. Selected course modules from this online program are valuable for management and clinicians throughout a hospital or health system.

This certification program covers:
  • Various managed care models (HMO, PPO, POS)
  • Carve-outs, inpatient stop-loss, short-stay stop-loss, and withhold pools
  • Payment models proposed under healthcare reform and their differences
  • Physicians' role in addressing utilization and quality of care
  • Key negotiation strategies
  • How payers evaluate their risks
  • Changes to HIPAA privacy laws included in ARRA
  • Principles behind outcomes-based reimbursement and incentives related to pay-for-performance programs
  • Relevant legislative changes affecting Medicare managed care
After this program, you'll be able to..
  • Identify key factors that influenced the development of managed care
  • Identify the various managed care models
  • Describe the insurer medical cost ratio (MCR) or medical loss ratio (MLR)
  • List cost-sharing mechanisms used in managed care and identify some of their important features
  • Explain coordination of benefits, managed Medicare organizations, and TRICARE
  • Explain the basic reimbursement methodologies used for physicians
  • List some popular capitation-based cost-control incentives
  • Describe a typical contract negotiation process
  • Identify the trends and direction of case management in today's healthcare delivery system
  • 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
  • Explain the purpose of NCQA
  • Describe major discussion points in the national healthcare debate
  • Explain the effects of increased consumer awareness
  • Describe the principles behind outcomes-based reimbursement and incentives related to pay-for-performance programs

Related Courses | Managed Care

Course | Intermediate | Accounting and Financial Reporting

Promote Yourself: Accounting & Finance

This program provides an overview of healthcare accounting and finance to strengthen competencies in understanding payment models and revenue management. It consists of 14 courses, each with its own assessment:

  • An Overview of Budgeting and Forecasting
  • Budgeting and Forecasting
  • Understanding IRS Form 990
  • Medicare and Medicaid Reimbursement Systems
  • Cost Analysis and Management
  • Financial Reporting: Revenue and Assets
  • Financial Planning and Budgeting
  • Accounting Oversight and Internal Control
  • Capital Planning and Financing
  • Financial Reporting: Relationships and Procedures
  • Financial Reporting: Liabilities and Long-Term Debt
  • Investments and Cash Management
  • Reimbursement and Managed Care
  • Malpractice Insurance and Risk Management

Course | Intermediate | Managed Care

Promote Yourself: Managed Care

This online program provides an overview of the state of managed care today and describes various managed care models affect the quality and cost of health care. It consists of seven courses, each with its own assessment:

  • Overview of Managed Care
  • Trends in Healthcare Policy
  • Essentials of Medicare and Medicaid Managed Care
  • Healthcare Delivery Systems
  • Managed Care Contracting and Negotiating
  • Provider and Payer Infrastructure and Process
  • Managed Care Reimbursement Methodologies

Certification | Intermediate | Revenue Cycle

Certified Revenue Cycle Representative (CRCR)

Healthcare rules are becoming more complex. Patients are demanding a better experience. Your staff is being held at a higher level of accountability than ever before.

With the industry's shift from volume to value, it is essential that revenue cycle staff have a broad understanding of the contemporary revenue cycle and how it influences the financial outcomes of the organization.

HFMA's CRCR is the only content available today that provides a national-level certification for addressing the contemporary patient-centric revenue cycle. Discover how comprehensive CRCR training for your revenue cycle staff can help your organization.

Certification | Intermediate | Accounting and Financial Reporting

Certified Specialist Accounting and Finance (CSAF)

The critical role of accounting and finance requires technical competencies used in decision support for all areas of healthcare management. The course provides an overview of healthcare accounting and finance to strengthen these competencies and address financial reports and statements unique to healthcare. In addition, the program provides a practical overview of risk-sharing arrangements, managed care contracts and profitability ratios.