Earn up to 35 hours of AMA PRA Category 1 Credit™: 

Introduction to Medicare
1. Why Understanding Medicare Matters for Physician Executives
2. Distinguishing Medicare From Other Insurance
3. Brief Historical Context of Medicare
4. Who Qualifies for Medicare & Enrollment Basics
5. Medicare’s Overall Structure: A, B, D, and a Note on C
6. Deep Dive into Medicare Part A
7. Deep Dive into Medicare Part B
8. Deep Dive into Medicare Part D
9. Common Misconceptions & Practical Tips
10. Practical Tips for Physician Executives:
11. Key Takeaways & Action Items for Physician Executives
12. References & Suggested Readings
Medicare Advantage (MA) Deeper Dive
1. Overview of Medicare Advantage (H Contracts)
2. Benchmark Setting
3. Bid Submission Process
4. Risk Adjustment in MA Payments
5. Payment Methodology and Revenue Flow
6. Regulatory Considerations and Compliance
7. Case Study: End-to-End Example
Comprehensive Guide to Delegated Medical Groups and Risk Contracts
1. Introduction
2. Forms of Risk Contracts
3. Financial Responsibilities and Risk Sharing
4. Key Metrics for Cost Management
5. Why Payers Delegate Risk to Medical Groups
6. Regulatory Considerations
7. Vendor and Solutions Considerations
8. Conclusion
Managed Care, Utilization Management, Case Management
1. Introduction
2. Managed Care Models
3. Medical Management, Utilization Management, and Case Management
4. Differences Between Utilization Management (UM) and Case Management (CM)
5. Roles in Different Payment Models
6. How These Functions Operate in Delegated Medical Group Arrangements
7. Regulatory and Compliance Considerations
8. Conclusion
Medicaid
1. State-Run vs. Managed Care Organizations (MCOs)
2. Payment Structures in Medicaid
3. Risk Management in Medicaid
4. Working with Vendors in Medicaid
5. Funding Sources and Medicaid Financing
Payment Models and Client Definitions in U.S. Healthcare
1. Overview of Payment Models
2. Fee-for-Service (FFS)
3. Value-Based Care (VBC)
4. Self-Insured Employers
5. Administrative Services Only (ASO) / Third-Party Administrators (TPA)
Accountable Care Organizations (ACOs) in the U.S. Healthcare System
1. Definition and Overview
2. Types of ACOs
3. Regulatory Frameworks and Legal Considerations
4. Financial Modeling and Reimbursement Structures
5. Operational Considerations
6. Comparison with Other Advanced Payment Models
7. Real-World Case Studies
8. Future of ACOs
Revenue Cycle Management (RCM)
1: Introduction to Revenue Cycle Management (RCM)
2: Medical Billing Basics
3: Medical Coding Fundamentals
4: CMS Guidelines and Private Insurance Rules
5: Claims Submission and Processing
6: Denials Management
7: Compliance and Legal Considerations
8: Practical Case Studies and Scenarios
Healthcare Payment Mechanics
1. Introduction to Healthcare Payment Systems
2. Payment Processing Workflows
3. Payer Contracting and Negotiations
4. Claims Adjudication and Reimbursement
5. Revenue Reconciliation and Financial Management
6. Role of Lockboxes, Clearinghouses, and Financial Institutions
7. Risk-Based Payment Models and Risk Sharing
8. Practical Case Studies and Scenarios
Payer Enrollment and Credentialing
1. Introduction
2. The Process of Payer Enrollment and Credentialing
3. Role of CAQH, PECOS, and Other Databases:
4. Challenges and Common Mistakes
5. Timeline for Enrollment and Credentialing
6. Medicare Enrollment vs. Other Payers
7. Impact of Geography on Enrollment
8. Enrollment and Credentialing of Individuals vs. Groups
9. The Role of Vendors in Payer Enrollment and Credentialing
10. Delegated Credentialing
11. Real-World Case Studies
Medicare and Payer Audits
1. Introduction
2. Types of Audits
3. Audit Triggers
4. Audit Process and Methodology
5. Appeal Process
6. Risks and Consequences
7. Compliance Strategies to Mitigate Risk 
Medicare Telemedicine, Remote Care, and In-Home Care: Payment Models & Strategies for Physicians
1. Introduction
2. Telehealth Services and Virtual Care
3. Remote Patient Monitoring (RPM)
4. Remote Therapeutic Monitoring (RTM)
5. Care Management Services (CCM, PCM, Others)
6. In-Home Evaluation & Management Services
CPOM, Friendly PC Ownership, and MSO Structures for Physicians
1. Introduction to CPOM
2. Friendly PC Ownership
3. PC-MSO Structures
4. Checklist for Physicians Evaluating a Friendly PC Ownership Opportunity
5. Case Studies and Examples
6. Conclusion & Next Steps
Concierge Medicine
1. Introduction
2. Historical Context
3. Regulatory Framework
4. Operational and Business Model
5. Risks and Challenges
6. Opportunities and Growth Potential
Collaborating Physician Arrangements
1. Introduction
2. Types of Collaborating Physician Arrangements
3. Responsibilities of a Collaborating Physician
4. Financial Aspects
5. Rules, Regulations, and Limits
6. Geographic Variations in Collaborating Physician Roles
7. Risks and Risk Mitigation Strategies
8. Opportunities for Collaborating Physicians
9. Case Studies 
Health Data Interoperability and Standards
1. Introduction
2. Key Interoperability Standards
3. Regulatory and Policy Frameworks
4. Challenges and Future Trends
Automation and AI in Healthcare
1. Introduction: A Strategic Imperative for Healthcare Leaders
2. Predictive Analytics for Clinical and Operational Excellence
3. AI-Driven Clinical Decision Support Systems
Precision Medicine and Personalized Care at Scale
4. Robotic Process Automation in Healthcare Operations
5. AI in Revenue Cycle and Administrative Processes
6. Leadership Considerations and Future Outlook
Introduction to Key Federal Health Care Laws and Regulations
1. Introduction
2. Physician Self-Referral Law
3. Anti-Kickback Statute
4. False Claims Act
5. Civil Monetary Penalties Law
6. Health Insurance Portability and Accountability Act
7. Conclusion

Join our faculty, physician executives, other students, investors, and partners in our private LinkedIn group for networking and continued learning and sharing of resources and opportunities.

We curate our own list of opportunities that we receive through various channels and distribute those via email and the LinkedIn group. These include:

• Friendly PC owner
• Collaborating physician 
• Medical director / CMO 
• Startup advisor or board member
• Expert witness
• Utilization management
• Health plan roles
• Executive and CareOps roles
• Consulting
• Sales and BD roles

6 months of access to our monthly office hours with various faculty, giving students an opportunity for live Q&A, advice, networking and deeper knowledge. 

In this bonus section, we've curated our favorite online videos that teach you key business skills:

• Excel / Google Sheets mastery

• Financial statements

• Pro formas and modeling

• Financial terminology

• Business communications

• Pitch decks and powerpoints

• Presentation skills

• AI & automation tools

• and more

Earn your ClinX Healthcare Executive Certificate. This certificate is awarded for mastery of healthcare business, operations, strategy and leadership frameworks. Award requires completion of the final exam with a passing grade.