Certified Specialist Payment & Reimbursement

The Certified Specialist Payment & Reimbursement (CSPR) course is an intensive program tailored for professionals seeking expertise in navigating the intricate landscape of healthcare payment systems. Spanning twelve modules, the course offers a comprehensive overview of managed care, Medicare and Medicaid reimbursement, healthcare delivery systems, and emerging trends in payment methodologies. Participants delve into topics such as case and utilization management, healthcare policy trends, industry regulations, and contracting strategies. Through interactive discussions, case studies, and assessments, participants gain practical skills to effectively manage payment and reimbursement processes, ensuring they are well-prepared to tackle the challenges and complexities of financial management within the healthcare industry.

Learning Objectives:

Participants who successfully complete this course will be able to:

• 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