Advanced Health Care Payment Systems
Advanced Health Care Payment Systems is designed to familiarize students with the various health care payment systems that are used by various healthcare payers. The course focuses on Medicare's prospective payment systems for hospital and other provider type reimbursement. It also covers New York State Medicaid reimbursement issues and provides a general understanding of the healthcare charge structure. The course will also focus on the fundamentals of establishing a compliance program to identify and prevent fraud and abuse issues.
Payment methods serve as a regulatory and market mechanism guiding the direction and activities of healthcare providers. It is essential that decision makers understand and assess the impact of reimbursement methodologies and the interaction between healthcare regulation, reimbursement methodologies and financial decision making.
This course will familiarize students with payment methodologies as directed by current Federal and New York State health care regulations and market forces. The course focuses on reimbursement for institutional and professional services.
The course includes analysis of actual reimbursement techniques and will familiarize students with the source documents and the process necessary for the analysis of Federal and New York State regulations. Current reimbursement topics will also be discussed and references will be made to newly released information from governmental agencies.
HPAM-GP.4830, HPAM-GP.4840; PADM-GP.4130 concurrently