Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Delivery Method:

Self Study

Course Availability:

18 Months

Recommended for:

Payer Contracting

Career level:

Early Careerist
Experienced Professional
Student

Audience:

Business Partners
Hospitals and Other Providers

Advance Preparation:

None

Prerequisites:

None
Course | Overview | Managed Care

This course explores trends in the ongoing development of state and federal healthcare policies and covers topics related to the national healthcare debate. It also discusses increased employer and consumer awareness and its impact on healt...

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Course | Overview | Managed Care

This course discusses financial management, the central thread that interconnects the various elements of managed care. It explains various reimbursement methodologies commonly used in managed care and the underlying assumptions and risk ma...

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Course | Overview | Managed Care

This course provides an overview of the state of managed care today and discusses how and why it has evolved. It also identifies major initiatives that are currently affecting managed care and will continue to do so in the future, as the U....

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Course | Overview | Managed Care

This course discusses criteria to use in evaluating the written contract between the provider and managed care organization, which defines the rights and obligations of the parties under the health plan/provider relationship. It also define...

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Course | Intermediate | Managed Care

This course provides an overview of cost-accounting strategies related to managed care payment and contract issues. It also explains some of the modeling tools that providers can use to evaluate managed care contracts. It presents a broad o...

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Course | Overview | Managed Care

Mgd Care: Healthcare Delivery Systems

Course | Overview | Managed Care

Mgd Care: Healthcare Delivery Systems

Description

This course discusses the healthcare delivery system in the U.S. and describes how various managed care models affect the quality and cost of care. It also describes the various relationships between providers and payers. Finally, it addresses cost-sharing mechanisms such as copayments, coinsurance, and out-of-pocket maximums that managed care models use to direct their members' choices of providers and services.
After this program, you'll be able to..
  • Define the terms Medical Cost Ratio (MCR) and Medical Loss Ratio (MLR)
  • Identify four cost-sharing mechanisms used in managed care
  • Define the terms tiering and tired network

Related Courses | Managed Care

Course | Overview | Managed Care

Mgd Care: Trends in Healthcare Policy

This course explores trends in the ongoing development of state and federal healthcare policies and covers topics related to the national healthcare debate. It also discusses increased employer and consumer awareness and its impact on healthcare policies, outcomes-based reimbursement approaches, and improved outcomes and increased value through coordination of care. The course examines the key issues behind healthcare reform and the main elements of the 2010 law.

Course | Overview | Managed Care

Mgd Care: Reimbursement Methodologies

This course discusses financial management, the central thread that interconnects the various elements of managed care. It explains various reimbursement methodologies commonly used in managed care and the underlying assumptions and risk management funding mechanisms that are responsible for these reimbursement methodologies. This course describes basic and advanced reimbursement methodologies used for hospital services and basic reimbursement methodologies used for physicians and other professionals.

Course | Overview | Managed Care

E2MC01-Overview of Managed Care

This course provides an overview of the state of managed care today and discusses how and why it has evolved. It also identifies major initiatives that are currently affecting managed care and will continue to do so in the future, as the U.S. continues to implement the reforms associated with the passage of the Patient Protection and Accountable Care Act (ACA) in March 2010. The course offers a solid foundation of knowledge that will provide necessary context for the more detailed information presented in subsequent courses in this series.

Course | Overview | Managed Care

Mgd Care: Contracting and Negotiating

This course discusses criteria to use in evaluating the written contract between the provider and managed care organization, which defines the rights and obligations of the parties under the health plan/provider relationship. It also defines key contract terminology, provisions, and clauses and describes reimbursement levels and methodologies. It highlights general issues that commonly arise during the contract negotiation process and describes common negotiation strategies. It defines direct contracting and third-party contracting and points out the differences between them.