Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Audience:

Hospitals and Other Providers
Business Partners
Physicians and Other Practitioners

Career level:

Student
Early Careerist

Recommended for:

Patient Access
Revenue Cycle
Billing
Claims
Managed Care
Patient Financial Services
Physician Practice
Reimbursement

Delivery Method:

Self Study

Advance Preparation:

None

Prerequisites:

None

Course Availability:

18 Months

News | Health Plan Payment and Reimbursement
Provider burdens from health plans’ use of prior authorization continue to mount amid calls to make the process fully automated.
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Blog | Health Plan Payment and Reimbursement
A review of the FY20 appropriations package to fund the federal government and a couple of ideas on lessons that might be applied to future efforts to expand coverage.
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News | Health Plan Payment and Reimbursement
Bonus-based value payment models have proliferated among employer health plans, while risk-based payment and performance on clinical quality indicators have not changed significantly, according to a recently published scorecard.
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Podcast | Health Plan Payment and Reimbursement
America's Health Insurance Plan President and CEO Matt Eyles discusses how health plans view price transparency and other issues facing the industry.
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News | Health Plan Payment and Reimbursement
Two health plans shared the ways they’ve improved digital engagement with both patients and providers.
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Course | Overview | Health Plan Payment and Reimbursement

Health Plans - An Overview

Course | Overview | Health Plan Payment and Reimbursement

Health Plans - An Overview

Description

In this course we will address the basic billing rules for major health plans, including an overview of basic billing features and benefits, types of billing rules and minor claim payers and plans.

Estimated course completion time: 30 minutes
After this program, you'll be able to..
  • Recognize the basic features of major government-funded health plans
  • Identify the basic features of other health plans including commercial plans and smaller government-funded plans

Related Courses | Health Plan Payment and Reimbursement

Course | Basic | Payment, Reimbursement, and Managed Care

The UB-04 Billing Form: Form Locators 1 through 41

This course explains how to complete FL 1-41 of the UB-04 billing form. This course covers the use of this form for all payers, including Medicare, Medicaid, and commercial payers. The course describes each form locator and provides detailed information about the codes needed to fill in these data areas.


Estimated course completion time: 1 hour and 30 minutes

We also offer The UB-04 Billing Form: Form Locators 42 through 81 here.

Course | Intermediate | Denials Management

Exception-Based Processing - Non-Paid Claims

This course addresses follow-up procedures for unresolved health plan and liability payer, also known as third-party payers, accounts and common account resolution procedures and activities specific to lien issues.

Course | Basic | Payment, Reimbursement, and Managed Care

The UB-04 Billing Form: Form Locators 42 through 81

This course explains how to complete FL 42-81 of the UB-04 billing form. The codes needed to fill in these data areas are described. The course covers the use of this form for all payers, including Medicare, Medicaid, and commercial payers.

Estimated course completion time: 1 hour and 30 minutes

We also offer the UB-04 Billing Form: Form Locators 1 through 41 here.

Course | Basic | Patient Access

Importance of Insurance Verification

In this course we highlight the various types of health insurance that your patients may present at registration. We'll review the fundamentals of Medicare, Medicaid, and third-party liability plans. You'll learn how verifying a patient's insurance eligibility and benefits affect the coordination of benefits process, which determines the primary payer and secondary payer on a claim.


Estimated course completion data: 30 minutes