Reimbursement is the language of healthcare finance. This track explains how Medicare pays hospitals, physicians and post-acute providers; how Medicaid is structured and financed; how managed care plans operate and contract; and how value-based arrangements are built on top of all three. It closes with practical contracting and reimbursement analysis skills. Each lesson includes a worked example and an action step.

Modules

The Payment Landscape

Lessons

• Who Pays for Healthcare in the United States Preview
• Medicare Structure: Parts A, B, C and D
• Medicaid Structure and Financing

Medicare Payment Systems

Lessons

• Inpatient and Outpatient Hospital Payment
• Physician Fee Schedule
• Post-Acute and Other Payment Systems

Medicaid Payment and Policy

Lessons

• Medicaid Fee-for-Service and Managed Care Rates
• Supplemental and Directed Payments
• Medicaid Managed Care Organisations

Managed Care Contracting

Lessons

• How Health Plans Work
• Contract Terms and Rate Structures
• Negotiation Strategy

Value-Based and Alternative Payment Models

Lessons

• Shared Savings and Accountable Care
• Bundled Payments and Episodes
• Capitation and Full Risk

Reimbursement Analysis in Practice

Lessons

• Cost Reports and Cost-Based Reimbursement
• Revenue Integrity and Compliance
• Case Study: A Reimbursement Turnaround