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Join a dynamic learning community where RBHC providers lead the way in integrated, value-based care.

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Financial Management Of Prospective Payment & Value-Based Reimbursement

Strong financial operations are essential to sustaining high-quality care. Prospective payment and value-based reimbursement change how organizations budget, bill, and plan. This track shows you how to build clear cost models, streamline revenue workflows, and understand your financial risk—so you can set fair rates and protect your margin.

Learn how to break down the pieces of PPS, map out new revenue-cycle tasks, and build simple tools that help you forecast bonuses, withholdings, and service costs. The goal: fewer surprises, smoother operations, and more confidence in every contract you sign.

Financial Management Of Prospective Payment & Value-Based Reimbursement

What you will learn

  • Prospective Payment Models Primer
  • Service Line Cost Reporting & Modeling
  • Revenue Workflow Automation
  • RCM Transformation Fundamentals
  • Scenario Planning for Leadership

This Learning Track includes

  • 17 Video Modules
  • 17 downloadable resources
  • 5 hours approx. video content
  • 4 Interactive Tools

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Learning Track Content

Topic 1: Prospective Payment Models Primer – Understanding PPS with real-world NC Examples

Module 1: NC PPS-APM Wrap Overview

Module 2: CCBHC Rate Structures

Module 3: Care Management Capitation Basics

Module 4: Comparative Analysis Framework

Module 5: Governance & Negotiation Checklist

Topic 2: Fundamentals of RCM Transition

Module 1: Denial Management Strategies

Module 2: Billing Workflow Redesign

Module 3: Coding & Documentation Accuracy

Module 4: AR Aging & Cash Posting Optimization

Module 5: Reconciliation & Reporting Routines

Topic 3: Service Line Cost Reporting & Modeling

Module 1: Identify Cost Components

Module 2: Build A Cost Allocation Template

Module 3: Sensitivity & Volume Scenarios

Module 4: Rate-Setting Implications

Topic 4: Risk-Corridor & Quality Withhold Forecasting

Module 1: Program Mechanics & Measures

Module 2: Forecasting Horizon & Cadence

Module 3: Performance Threshold Mapping

Module 4: Scenario Modeling Techniques

Module 5: Governance & Reporting Routines

Topic 5: Scenario Planning & Sensitivity Analysis

Module 1: Key Variable Identification

Module 2: Tiered Scenario Construction

Module 3: Margin Impact Analysis

Module 4: Cost-Driver Stress Testing

Topic 6: Managing Medical Cost & MLR Under PPS: Reporting Routines & Guardrails

Module 1: MLR Program Structure & Thresholds

Module 2: Reporting Cadence Recommendations

Module 3: Cost Attribution Best Practices

Module 4: Variance Analysis & Exception Flagging

Module 5: Guardrail development

Experts

Rebecca Babigian

Formerly Chief Executive Officer

Integrated Healthcare Partners

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Sharon Hicks

Formerly Chief Operating Officer

Community Care Behavioral Health

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Raymond Wolfe

Formerly Chief Operating Officer,

Pittsburgh Mercy Health System

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Learning Track Preview