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Hospitals and Other Providers
Business Partners
Physicians and Other Practitioners

Career level:

Experienced Professional
Early Careerist

Recommended for:

Physician Practice
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:




Course Availability:

18 Months

News | Medicare Payment and Reimbursement
Medicare plans to add pandemic-era waivers to its value-based payment models as a way to incentivize provider participation.
News | Medicare Payment and Reimbursement
Proposed OPPS cuts for 340B hospitals and outpatient payment changes drew the most concerns from hospitals and advocates.
News | Medicare Payment and Reimbursement
Medicare physician payment changes for evaluation and management could have dire financial repercussions for some practices, providers warn.
News | Medicare Payment and Reimbursement
Hospitals will get some flexibility in the repayment of Medicare advance payment loans and a delay in uncompensated-care payment cuts under a new federal funding law.
Blog | Medicare Payment and Reimbursement
Recently passed legislation relaxes terms of the Medicare Advanced and Accelerated Payment Program loans for hospitals and and other providers.
Course | Overview | Medicare Payment and Reimbursement

Essentials of Medicare and Medicaid Managed Care

Course | Overview | Medicare Payment and Reimbursement

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
After this program, you'll be able to..
  • Provide an overview of Medicare and its history
  • Recognize how the Centers for Medicare and Medicaid Services (CMS), the Federal Trade Commission (FTC), the Internal Revenue Service (IRS), the Office of the Inspector General (OIG), the Department of Justice (DOJ), the Securities and Exchange Commission (SEC), and the U.S. Public Health Service administer and regulate Medicare
  • Define the Inpatient Prospective Payment System
  • Recognize the Outpatient Medicare Prospective Payment System
  • Recognize how Medicare provides payment to physicians
  • Recognize relevant legislative changes affecting Medicare managed care
  • Recognize demonstration projects
  • Recognize examples of these projects
  • Identify key elements of ABNs
  • Identify the rights and responsibilities of Medicare enrollees
  • Recognize the features of Medicare Part D
  • Identify how healthcare providers are paid under Medicaid
  • Recognize successes and failures of Medicaid managed care

Related Courses | Medicare Payment and Reimbursement

On Demand Webinar | Overview | Coding

Are your ready for the 2021 CPT E/M Office Visit changes?

New E/M office visit codes go into effect January 1, 2021. These codes cover a large percentage of the healthcare delivered today.  Because these codes haven't had substantial changes since 1992, the impact of this rule is likely to be far reaching. There are implications for hospitals, health systems and health plans, in addition to physicians and practice plans. This webinar will provide an overview of the upcoming changes, and what you need to know to begin preparing your organization for a successful transition.

Original Live Webinar Date: 10/7/20

On Demand Webinar | Update | Legal and Regulatory Compliance

2021 Proposed Rule changes to OPPS and ASC Payment System

Prepare your organization now for the proposed CY21 changes to the ambulatory surgery center (ASC) payment system and the hospital outpatient payment system (OPPS) CY21. Find out what changes are proposed for implementation on January 1, 2021, for ASCs and hospital leaders will not want to keep a close watch on ASC and OPPS developments as more services migrate from one setting to another.

Topics include proposed 2021 changes to:

  • APC groupings
  • OPPS changes to drugs, biological, and radiopharmaceuticals
  • OPPS for packaging
  • Inpatient Only List
  • ASCs
  • Hospital outpatient and ASC quality requirements
  • Additional changes to other policy areas

Original Live Webinar Date: 9/10/20

On Demand Webinar | Overview | Coronavirus

Patient care in crisis: How to launch, code and bill telehealth services (Spring 2020 Virtual Conference On-demand)

Due to the coronavirus/COVID-19 crisis, physicians and health leaders are under tremendous pressure to meet the demands of patient care while stabilizing operational and financial health. This session will showcase a telehealth demonstration and discuss how providers can implement telehealth quickly and efficiently.

Original live session date: 4/9/2020

Course | Basic | Medicare Payment and Reimbursement


In this course we will address scheduling processes, including

  • Patient identification
  • Requested service
  • Medical necessity screening
  • Medicare Advance Beneficiary Notice of Noncoverage processing
  • Patient instructions
  • Scheduler instructions
  • Order requirements
Estimated course completion time: 30 minutes