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The Business of Health Care
Activity description
This activity will provide participants with an overview clarifying the dynamics by which the business of health care is affected by the processes of capturing a patient’s reason for their visit and the care provided in response. With a focus on accurate coding that justifies patient services or procedures performed by the provider, it will examine the role of diagnostic-related group (DRG) classifications in payment determination under the inpatient prospective payment system (IPPS), payment systems, ICD-10 coding requirements and payer criteria. The roles of revenue cycles, payer methodologies and patient access in the business of health care will also be examined.
Provided by
This activity is provided by Optum Health Education and Optum Advisory Services.
Commercial support
No commercial support was received for this activity.
Required hardware/software
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Target Audience
This activity is designed to meet the educational needs of case managers, nurses, social workers and other HCPs who have an interest in learning about how case management relates to the business of health care.
Learning Objectives
At the end of this activity, participants should be able to:
- Analyze evidence-based strategies for improving reimbursement, clinical care and patient throughput and understand their ties to coding systems.
- Explore how coding, documentation and patient access influence care delivery, quality and health care revenue.
- Discuss the revenue cycle in health care, including its benefits, advantages and challenges.
- Differentiate Medicare benefit days for various services, including inpatient admissions, skilled nursing facilities and inpatient rehabilitation services.
- Describe concurrent and retrospective denials and strategies to mitigate them.
Activity planners
Elizabeth Albert, MD
Clinical Activity Manager
Optum Health Education
Lacy Johnson, MSN, RN, CNL, PHN
Senior Consultant - Education
Optum Advisory Services
Provider Clinical Practice
Keith Jones DNP, MSN, RN, CEN
Education Manager, Optum Advisory Services
Provider Clinical Practice
Briana Sam, MS
Senior Consultant, Instructional Designer
Optum Advisory Services
Provider Clinical Practice
Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, Optum Health Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.
The activity faculty and planners have no financial relationships to disclose.
Method for calculating CE credit
CE credit was calculated by the complexity of content.
Accreditation statement
In support of improving patient care, this activity has been planned and implemented by Optum Health Education and Optum Advisory Services. Optum Health Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.
Credit designation statements
Case managers
The Commission for Case Manager Certification has approved this program for a maximum of 0.50 clock hours for Certified Case Managers (CCM).
Nurses
The participant will be awarded up to 0.50 contact hour(s) of credit for attendance and completion of supplemental materials.
Social workers
As a Jointly Accredited Organization, Optum Health Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Optum Health Education maintains responsibility for this course. Social workers completing this course receive 0.50 enduring continuing education credits.
Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization from which they wish to obtain credit.
Available Credit
- 0.50 ANCC - Nurses
- 0.50 Attendance - General Attendance
- 0.50 CCMC - General - Case Managers
You must be logged into your account to participate in this activity. Get started by clicking “Register/Continue” and following the instructions. At the end of the activity, you will be able to view, save or print your certificate of participation. A complete listing of all of your activities can be found under “My Account,” “My Activities.”