Course

Course Summary
Credit Type:
Course
ACE ID:
HFMA-0002
Location:
Online
Length:
13 hours
Dates Offered:
Credit Recommendation & Competencies
Level Credits (SH) Subject
Lower-Division Baccalaureate 1 health insurance and reimbursement
Description

Objective:

The course objective is to attain an understanding in and have demonstrated specialist-level knowledge of the managed care environment, payment rates, benefit coordination, reimbursement models, cost-control incentives, legislative changes, and more.

Learning Outcomes:

  • Identify key factors that influenced the development of managed care
  • Explain coordination of benefits, managed Medicare organizations, and TRICARE
  • Describe the role of Medicare and Medicaid Managed Care
  • Identify the clinical integration components of case management
  • Describe basic hospital service reimbursement methodologies and cost control incentives
  • Describe the impact of the ACA on reimbursement, and list emerging payment trends under healthcare reform
  • List key case and utilization (care) management and clinical integration components
  • Identify major trends in healthcare policy, including consumerism, outcomes-based reimbursement, and other elements of reform

General Topics:

  • Overview of Managed Care
  • Essentials of Medicare and Medicaid Managed Care
  • Healthcare Delivery Systems
  • Managed Care Reimbursement Methodologies
  • Managed Care: Incentives, Emerging Trends, and Risks
  • Managed Care: Trends in Case and Utilization Management
  • Provider and Payer Infrastructure and Process
  • Trends in Healthcare Policy
  • Healthcare Industry Regulation and Accreditation
  • Contracting and Negotiating
Instruction & Assessment

Instructional Strategies:

  • Computer Based Training

Methods of Assessment:

  • Examinations

Minimum Passing Score:

70%
Supplemental Materials