Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Delivery Method:

Self Study

Course Availability:

1 Year

Recommended for:

Payer Contracting
Physician Practice
Population Health

Career level:

Executive
Experienced Professional
Mid-Senior

Audience:

Business Partners
Hospitals and Other Providers
Physicians and Other Practitioners

Advance Preparation:

None

Prerequisites:

Familiar with development of Medicare planning strategies
Blog | Medicare Payment and Reimbursement

Details about the new five-year mandatory radiation therapy model released by CMS the week of July 8 are reviewed.

Save
Blog | Medicare Payment and Reimbursement

In the face of recent, multiple setbacks on the Trump administration’s proposals for drug pricing, the administration could move aggressively forward on its anticipated International Pricing Index Model for Part B drugs proposal.

Save
News | Medicare Payment and Reimbursement

Stay ahead of healthcare news and developments with this listing of hearings, conferences, webinars, public forums and deadlines for the week of July 14.

Save
News | Medicare Payment and Reimbursement

Rural-state hospitals strongly back a proposed Medicare area wage index (AWI) change, but national hospital advocates are warning against it.

Save
News | Medicare Payment and Reimbursement

Stay ahead of healthcare news and developments with this listing of hearings, conferences, webinars, public forums and deadlines for the week of July 8.

Save
On Demand Webinar | Intermediate | Medicare Payment and Reimbursement

Developing and operationalizing a successful Medicare Advantage strategy

On Demand Webinar | Intermediate | Medicare Payment and Reimbursement

Developing and operationalizing a successful Medicare Advantage strategy

Description

As the senior population continues to outpace the relative growth of the general population, and Medicare Advantage is accounting for about one-third (and growing every year) of all new Medicare eligible enrollees, providers are increasingly faced with the strategic questions of how best to engage with this rapidly expanding segment of their business portfolio. This question is further complicated by market disruptors, who are entering markets across the U.S. to aggregate independent physicians to manage this population.

The focus of this webinar is to raise awareness and understanding of the key considerations for:
  • Develop a market-tailored Medicare Advantage strategy
  • Define payer/contracting approaches and value propositions
  • Identify appropriate infrastructure and analytics
  • Establish high-performance networks and realizing successful execution
After this program, you'll be able to..
  • Assess the key considerations for developing a market-specific approach to pacing a transition to Value/Risk-based Medicare Advantage strategy
  • Review the spectrum of operational deliverables needed to support a successful Medicare Advantage strategy
  • Identify critical priorities behind each of those operational deliverables

Related Courses | Medicare Payment and Reimbursement

On Demand Webinar | Intermediate | Payment, Reimbursement, and Managed Care

Understanding the medicare shared savings program pathways to success final rule

On December 21, CMS finalized the Medicare Shared Savings Program Pathways to Success rule. The final rule represents the most sweeping changes to the program since its inception. While accelerating the transition to risk, the rule's changes to the benchmarking methodology and expanded opportunities to use telehealth, beneficiary incentives, and skilled nursing facility waivers increase opportunities for ACOs to succeed financially in the program. However, like under prior program rules, for ACOs to successfully improve patient outcomes and reduce the total cost of care, they will need an aligned funds flow model, infrastructure to support care redesign and individualized care plans, and strong partnerships with post-acute networks.

On Demand Webinar | Intermediate | Chargemaster

2019 final rule changes to the medicare hospital OPPS and ambulatory surgery payment system

The ambulatory surgery center (ASC) payment system continues to evolve with final changes to the hospital outpatient prospective payment system (OPPS) for calendar year 2019. Find out what changes are finalized for implementation on January 1, 2019 for ASCs and hospital outpatient services in the CY2019 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:

  • Final 2019 APC groupings
  • Final 2019 OPPS changes to drugs, biological, and radiopharmaceuticals
  • Final 2019 changes to OPPS for cancer hospitals and partial hospitalization services
  • Final 2019 changes to collect data on off-campus provider-based emergency departments
  • Final 2019 methods to control outpatient volume increases
  • Final 2019 340B drug payment changes for non-excepted off-campus hospital departments
  • Final 2019 changes for ASCs
  • Final changes to hospital outpatient quality requirements
  • Final additional changes to other policy areas

Course | Intermediate | Managed Care

Promote Yourself: Managed Care

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

Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)

This online program describes the nuts and bolts of managed care and thoroughly covers the issues surrounding healthcare reform. Selected course modules from this online program are valuable for management and clinicians throughout a hospital or health system.

This certification program covers:

  • Various managed care models (HMO, PPO, POS)
  • Carve-outs, inpatient stop-loss, short-stay stop-loss, and withhold pools
  • Payment models proposed under healthcare reform and their differences
  • Physicians' role in addressing utilization and quality of care
  • Key negotiation strategies
  • How payers evaluate their risks
  • Changes to HIPAA privacy laws included in ARRA
  • Principles behind outcomes-based reimbursement and incentives related to pay-for-performance programs
  • Relevant legislative changes affecting Medicare managed care