Course catalogue

Learn the basics of managed care contracting, including criteria-based contracting and how to monitor contract compliance

Learning Objectives

• Identify the purpose of a contract.
• Identify key components and common terms of a contract.
• Identify key components and common terms of a health plan/payer contract.
• Define criteria-based contracting and recognize an evaluation model.
• Identify elements to monitor for contract compliance during the contract term, at renewal, or when problems arise with the current contractor.

This program provides a focus on revenue cycle activities that enhance contemporary Ambulatory practice management. Those who earn this certification will also gain specialist-level knowledge related to budget preparation, financial projections, cost accounting, managing information systems, and evaluating and negotiating payer contracts. Also discusses the full range of topics and techniques that are central to the effective management of Ambulatory practices. Recommended for: Ambulatory Operations Manager, Practice Coordinator, Ambulatory Operations Director, Ambulatory Care Manager, etc.

Learning Objectives

• • Implement the key elements of patient registration, accounts receivable and collection processing
  • Identify the key contributory elements of evaluation and management services
  • Define ratios valuable in monitoring financial performance of a practice
  • Identify processes for evaluating a contract, legal and regulatory compliance
  • Identify elements of strategic planning, information technology and the role of marketing

CPE Award Amount: 11.5

Program Level: Intermediate

Program Prerequisite: Experience with management issues related to running a ambulatory practice, including compliance, revenue cycle management and leadership.

Recommended Experience: 1-2 years experience in ambulatory practice setting.

Advanced Preparation: None

Instructional Method: Self-Study

Delivery Method: QAS Self-Study

Field of Study & Topic in hours: 4.5 Finance - 7.0 Specialized Knowledge

Content last revised: August 2024

CPE Sponsor- Healthcare Financial Management Association is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.

For more information regarding refund policies, as well as any program concerns, please contact our offices at 800.252.4362 or, inquiry@hfma.org.

This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recent changes in the law affecting Medicare managed care contracting. This course also identifies the rights and responsibilities of Medicare enrollees. It also provides an overview of the Medicare Part D pharmacy benefit and points out some successes and failures of Medicaid managed care.

Learning Objectives

After completing this course, you will be able to:

• Provide an overview of Medicare and its history
• Recognize how the Centers for Medicare and Medicaid Services (CMS), the Federal Trade Commission (FTC), the Internal Revenue Service (IRS), the Office of the Inspector General (OIG), the Department of Justice (DOJ), the Securities and Exchange Commission (SEC), and the U.S. Public Health Service administer and regulate Medicare
• Define the Inpatient Prospective Payment System
• Recognize the Outpatient Medicare Prospective Payment System
• Recognize how Medicare provides payment to physicians
• Recognize relevant legislative changes affecting Medicare managed care
• Recognize demonstration projects
• Recognize examples of these projects
• Identify key elements of ABNs
• Identify the rights and responsibilities of Medicare enrollees
• Recognize the features of Medicare Part D
• Identify how healthcare providers are paid under Medicaid
• Recognize successes and failures of Medicaid managed care

Date: Thursday, October 22, 2026, 2:00 PM – 3:00 PM CST

Provider reimbursement is increasingly being shaped through regulation, litigation, political pressure and competing payer/provider narratives. This webinar describes what is changing with the No Surprises Act and the political and policy issues surrounding it, as well as what providers can control.

Learn from Eric Berger, Principal at Liberty Partners Group and Executive Director for Americans for Fair Health Care (AFHC) and Medical Practice Support Alliance (MPSA) and Seth Pfaltzgraff, Healthcare Client Director at Macedon Technologies, about strategies for increasing reimbursement as well as technologies to prevent revenue leakage.

Speaker

Seth Pfaltzgraff, Healthcare Client Director at Macedon Technologies, works with healthcare providers, revenue cycle leaders, and dispute resolution organizations to modernize the operational processes that sit behind reimbursement, appeals, and payment integrity.
Seth’s experience spans:

 • Revenue Cycle Management
 • No Surprises Act Open Negotiation & IDR Operations
 • Denials & Appeals Automation
 • Payer Contracting & Negotiation Management
 • AI-Driven Operational Workflows
 • Enterprise Process Automation
Over the past decade, Seth has helped organizations identify opportunities where technology, process design, and operational discipline can create measurable business outcomes. Seth focuses on helping healthcare organizations simplify complex work through workflow automation, AI, and digital transformation initiatives.
Seth enjoys connecting with healthcare operators, RCM leaders, payer strategy teams, and technology executives who are looking to improve outcomes through smarter processes.

Learning Objectives

• Understand key policy and market forces shaping provider reimbursement
• Assess evolving NSA, Qualifying Payment Amount, and enforcement developments
• Identify reimbursement risks across denials, appeals, and underpayments
• Explore how finance leaders can influence policy and strategy
• Evaluate technology-enabled approaches to improve reimbursement performance

CPE Information

• CPE Award Amount: 1.0 (60-minute segment)
• Program Level: Basic
• Program Prerequisite: None
• Advanced Preparation: None
• Delivery Method: Group Internet Based
• Topic: Payment Reimbursement and Managed Care
• Field of Study: Specialized Knowledge

CPE Sponsor- Healthcare Financial Management Association is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.

In order to receive CPE credit for this session, you must participate in 50 minutes of the presentation for this one hour program. You must also respond to the 4 polling questions that
will appear during the session and complete the online evaluation within 2 business days after the webinar.

For more information regarding refund policies, as well as any program concerns, please ...