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Hospitals and Other Providers
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Physicians and Other Practitioners

Advance Preparation:




Course Availability:

18 Months

News | Medicare Payment and Reimbursement
A complete listing of healthcare finance-related hearings, conferences, webinars, public forums and deadlines for the week of Feb. 17.
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.
Course | Basic | Medicare Payment and Reimbursement

Essentials of Medicare and Medicaid Managed Care

Course | Basic | 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 | 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 | Intermediate | Coding

Medicare Compliance Concerns

This course addresses specific Medicare compliance and coding issues. It will review terms such as MS-DRG window, Two-midnight rule, Correct coding initiative (CCI), modifiers, and Medicare secondary payer (MSP).

Estimated course completion time: 3 hours

Course | Basic | Self-Payment Collection

Self-Pay Follow Up

In this course we will address patient balance billing after insurance; contract issues and limitations; and required processing differences between bad debt and financial assistance care (such as charity). Appropriate notations are included within the course to direct you to the specific requirements of Section 501(r) of the Internal Revenue Code course related to financial assistance policies, applications and other requirements for non-profit hospitals in the handling of potential and eligible financial assistance patients. This course also includes an overview of Medicare bad debt rules and their financial impact.

Estimated course completion time: 30 minutes

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