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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
Federal assistance programs should stabilize hospital cash through the summer, when Medicare repayments will create major financial pressure.
News | Medicare Payment and Reimbursement
CMS wants hospitals to start reporting median health plan payment rates and may use the information to help determine Medicare rate changes.
News | Medicare Payment and Reimbursement
The federal government has begun to release financial assistance targeted to rural hospitals as they struggle with cash shortfalls amid the shutdown of elective procedures.
News | Medicare Payment and Reimbursement
A complete listing of healthcare finance-related hearings, conferences, webinars, public forums and deadlines for the week of May 4.
News | Medicare Payment and Reimbursement
Hospitals will have additional terms and conditions with which to comply if they accept a share of $20 billion in new federal assistance.
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 | 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

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

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 October 1, 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 October 1, 2020*.

*During this unprecedented time HFMA is committed to meeting the need of its certified individuals. HFMA is implementing a certification maintenance grace period to allow for additional time to meet the recertification requirement. The maintenance deadline will be extended from May 31, 2020 to October 1, 2020.