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Hospitals and Other Providers

Career level:

Early Careerist
Experienced Professional

Recommended for:


Delivery Method:

Self Study

Advance Preparation:




Course Availability:

18 Months

News | Medicare Payment and Reimbursement
For 2021, MedPAC has recommended that hospitals’ Medicare rates increase 2%, plus a potential 0.8% quality bonus and elimination of a 0.5% quality cut.
Blog | Medicare Payment and Reimbursement
CMS’s new BPCI-A model incorporates patient complexity into the risk-adjustment mechanism, but it remains to be seen if it will solve all issues with the previous model.
Fact Sheet | Medicare Payment and Reimbursement
CMS released the calendar year 2020 final rule for Medicare’s hospital outpatient prospective payment system and ambulatory surgical center payment system on November 1, 2019. Policies in the final rule will generally go into effect on Janu...
Column | Medicare Payment and Reimbursement
As Maryland's Medicare Total Cost of Care priogram enters its second year, it It is a goodtime to revisit the program to understand its essential elements and implications for the nation's healthcare system.
News | Medicare Payment and Reimbursement
A delay of a $4 billion cut to hospital DSH payments was included in a year-end federal funding package.
Course | Overview | Medicare Payment and Reimbursement

Compl: Reimbursement Issues

Course | Overview | Medicare Payment and Reimbursement

Compl: Reimbursement Issues


This course provides an overview of the prospective payment systems used in the Medicare program and as well as Medicare fee schedules. This course provides a general discussion and overview of Medicare reimbursement under the Inpatient Prospective Payment System (IPPS) and discusses specific instances in which a hospital may receive additional payments under the IPPS.

Estimated course completion time: 1 hour
After this program, you'll be able to..
  • Identify the general structure of a prospective payment system
  • Recognize the statutory history behind the implementation of the prospective payment system
  • Identify which Medicare programs are reimbursed using a prospective payment system
  • Recognize the physician fee schedule
  • Recognize the DMEPOS fee schedule
  • Recognize the clinical laboratory fee schedule
  • Identify the steps necessary to determine payment under the IPPS
  • Identify which services are not included in payment made under the IPPS
  • Recognize the purpose of an outlier payment and identify when an outlier payment may be made
  • Recognize the purpose of a disproportionate share adjustment and when such an adjustment may be made
  • Identify indirect medical education (IME) and recognize when an IME adjustment may be made

Related Courses | Medicare Payment and Reimbursement

On Demand Webinar | Update | Legal and Regulatory Compliance

2020 Final Rule changes to Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Centers (ASC)

The ambulatory surgery center (ASC) payment system continues to evolve with the proposed changes to the hospital payment system (OPPS) for calendar year 2020. Fnd out what changes are proposed for implementation on January 1, 2020 for ASCs and hospital outpatient services in the CY2020 final rule. Physician practice managers will want to keep a close watch on the ASC and OPPS developments as more services migrate from one setting to another. Prepare your organization now for the proposed changes.

Topics Include:

  • Latest update on CMS' pricing transparency initiatives
  • 2020 OPPS changes to drugs, biological, and radiopharmaceuticals
  • 2020 340B drug rules
  • 2020 changes to OPPS for cancer hospitals and partial hospitalization services
  • 2020 changes to OPPS packaging
  • 2020 methods to control outpatient volume increases related to clinic visits
  • 2020 changes for ASCs
  • 2020 changes to hospital outpatient and ASC quality requirements
  • Additional changes to other policy areas such as prior authorizations and laboratory date of service rules
Original Live Webinar Date: 12/17/19

Course | Basic | Managed Care

Mgd Care: Essentials of Medicare and Medicaid Managed Care

This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recent changes in the law affecting Medicare managed care contracting. This course also identifies the rights and responsibilities of Medicare enrollees. It also provides an overview of the Medicare Part D pharmacy benefit and points out some successes and failures of Medicaid managed care.

Estimated course completion time: 1 hour

On Demand Webinar | Overview | Financial Leadership

Proposed Changes to the Physician Self-Referral (Stark) Law to Promote Value-Based Payments

The Centers for Medicare and Medicaid Services (CMS) has proposed the most sweeping changes to the regulations that interpret the physician self-referral law (the "Stark Law") in over twenty years. This webinar will principally focus on how the newly-proposed regulations, if finalized, would afford hospitals, physician groups, clinics, and other care providers significant additional flexibility to compensate physicians for collaboration on value-based care arrangements involving commercial, Medicare, or other patient populations. It will also provide an overview of other helpful proposed changes affecting an even broader array of physician compensation arrangements.

Original live webinar date: 11/18/19

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.