Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Audience:

Health Plans
Hospitals and Other Providers
Physicians and Other Practitioners

Career level:

Experienced Professional

Recommended for:

Billing
Healthcare Economics
Managed Care
Payer Contracting
Physician Practice
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:

None

Prerequisites:

None

Course Availability:

12 Months

Blog | Managed Care
New survey results: Those that favor Medicare for All are more dissatisfied with the cost of healthcare and concerned about paying for care if they became ill.
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Blog | Managed Care
Hospital finances could be significantly impacted by UnitedHealthcare’s expansion of site-of-service prior authorization requirements going into effect Nov. 1.
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Certification | Overview | Managed Care
The CSMC recertification program is recommended for active, eligible, HFMA CSPPM certificants with an upcoming maintenance due date of May 31, 2020. Not sure when your CSMC expiration date is? Sign in, click your profile image in the upper ...
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Blog | Managed Care
A discussion on the unsustainable growth rate of employer-sponsored health benefits and how industry participants can help them.
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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 | Intermediate | Managed Care

Promote Yourself: Managed Care

Course | Intermediate | Managed Care

Promote Yourself: Managed Care

Description

This online program provides an overview of the state of managed care today and describes various managed care models affect the quality and cost of health care. It consists of seven courses, each with its own assessment:
  • Overview of Managed Care
  • Trends in Healthcare Policy
  • Essentials of Medicare and Medicaid Managed Care
  • Healthcare Delivery Systems
  • Managed Care Contracting and Negotiating
  • Provider and Payer Infrastructure and Process
  • Managed Care Reimbursement Methodologies
After this program, you'll be able to..
  • Identify key factors that influenced the development of managed care
  • Identify the various managed care models
  • Describe the insurer medical cost ratio (MCR) or medical loss ratio (MLR)
  • List cost-sharing mechanisms used in managed care and identify some of their important features
  • Explain coordination of benefits, managed Medicare organizations, and TRICARE
  • Explain the basic reimbursement methodologies used for physicians
  • List some popular capitation-based cost-control incentives
  • Describe a typical contract negotiation process
  • Identify the trends and direction of case management in today's healthcare delivery system
  • Identify the clinical integration components of case management
  • List the two main issues to consider when discussing the safe use of EHRs
  • Discuss the potential results of EHR's emphasis in providing one standardized clinical data structure and presentation
  • Explain the purpose of NCQA
  • Describe major discussion points in the national healthcare debate
  • Explain the effects of increased consumer awareness
  • Describe the principles behind outcomes-based reimbursement and incentives related to pay-for-performance programs

Related Courses | Managed Care

Certification | Overview | Revenue Cycle

Certified Revenue Cycle Representative Recertification

The CRCR recertification program is recommended for active, eligible, HFMA CRCR certificants with an upcoming maintainance due date of May 31, 2020. Not sure when your CRCR 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 the page. You'll see your certifications along with their expiration date. 


HFMA required that eligible CRCR certificants gain contuing competence in the revenue cycle arena by taking a short assessment every two years.  The program provides healthcare organizations with a means to ensure that their revenue cycle staff has the body of knowledge necessary to meet their demands. 

Click here to see the list of specific topics covered in this year's recertification course. 

Assessment information:
This online program includes the recertification course 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 May 31, 2020.


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 May 31, 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 May 31, 2020.

Certification | Overview | Accounting and Financial Reporting

Certified Specialist Accounting & Finance Recertification

The CSAF recertification program is recommended for active, eligible HFMA CSAF certificants with an upcoming maintenance due date of May 31, 2020. Not sure when your CSAF 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 the page. You'll see your certifications along with their expiration date.


HFMA requires that eligible CSAF certificants gain continuing competence in the accounting and finance 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. 

CSAF recertification course outline:
  • Financial Planning and Budgeting
  • Financial Reporting: Liabilities and Long-Term Debt
  • Financial Reporting: Relationships and Procedures
  • Financial Reporting: Revenue and Assets
  • Accounting Oversight and Internal Control
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 May 31, 2020.


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.


Estimated course completion time: 1 hour and 15 minutes