The Managed Care Catalog
[Note: The 'number' preceding the 'letter' in the course designation - e.g., 4A, 3D, 4D, 5B, 10A - denotes the number of credit hours awarded for the course.
See the table of courses below for a quick overview of our prices.]
Then just click the + sign next to any course that you want to know more about,
AT THE BOTTOM OF THE PAGE.
Check out our Annual Subscription Feature
It's only $59.95 for an entire year of unlimited CE Courses and CEUs.
And try our FREE CE COURSE 1B - It awards one (1) CEU!
Our Managed Care Courses focus upon the oftentimes nerve-wracking ethical and practical scenarios brought about by ever-expanding 'Managed Health Care' - and might well be called 'Recipes for Managed Care Success' . . . or 'How To Survive It Ethically', depending upon your perspective. With the implementation of Health Care Reform at the federal and state levels, virtually all insurance carriers and their provider networks will be affected.
These courses are appropriate for all licensed behavioral health providers - whether in private practice, or working for a private or publicly funded program. Programs affected include outpatient treatment programs and practices, hospitals, nursing facilities, Community MHMR Centers, residential treatment centers, Block Grant Substance Abuse treatment programs, recovery and rehabilitation centers, etc..
These courses are relevant for all behavioral health providers who are (or will be) providing treatment under a Care Management system - i.e., a contract with a Managed Care company (such as a BHO, MCO or HMO) or any other type of insurance carrier or government agency which utilizes 'Care Management' in its dealings with service providers. This includes private insurance carriers as well as those who administer Medicaid and Medicare and state or local chemical dependency contracts.
To see DETAILS or to PURCHASE any of the courses listed in the price list below, go to the BOTTOM of this page and click the + sign next to any course title that interests you.
| CEUs |
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Price |
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Course |
| 3 |
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$24.00 |
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Ethics 3D - The Ethics of Treatment Documentation When Insurance Is Paying The Bill |
| 4 |
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$28.00 |
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Ethics 4D - The Ethics of Treatment Documentation and Other Ethical Dilemmas When Insurance Is Paying The Bill |
| 3 |
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$23.00 |
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Course 3B - Addiction & Substance Abuse Treatment - 'The Big Transition' |
| 2 |
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$17.50 |
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Course 2B - They're Coming to Audit WHEN? |
| 2 |
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$17.50 |
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Course 2C - We Have to Change WHAT? |
| 3 |
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$23.00 |
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Course 3A - Managed Care - Is There Anything GOOD About It? |
| 5 |
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$28.00 |
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FlexiCourse 5A - Welcome to Care Management! Do They REALLY Need Treatment? |
| 5 |
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$28.00 |
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Course 5B - Managed Care Contract? Survive It, Professionally! |
| 1 |
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$10.00 |
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FREE FREE FREE! Course 1B - Intro to Behavioral Health Programs Within a Managed Care Environment |
| 1 |
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$10.00 |
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Course 1C - That 'Capitation Thing' and YOU! |
| 10 |
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$40.00 |
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FlexiCourse 10A - $40.00 - The Big Course On Managed Care For Professionals |
| 4 |
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$26.00 |
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FlexiCourse 4A - This Is Managed Care - and Its Impact on YOU! |
REGARDING OUR FLEXI-COURSES .... Courses 10A, 4A, and 5A: These three Managed Care courses (FlexiCourses 4A, 5A, and 10A) are organized into convenient modules or chapters which allow you to collect a certificate for each separate module - collect all now, or save some for later when you need them! The 10 Credit Hour Course 10A is priced at only $40!
To see DETAILS or to PURCHASE any of the courses listed in the price list below, go to the BOTTOM of this page and click the + sign next to any course title that interests you.
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FREE Course 1B - Intro to Behavioral Health Programs Within a Managed Care Environment |
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Earn a certificate for 1 or 0.1 credits immediately upon completion of this module.
Only $0.00
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Course 1B - It's Not Your Grandpa's Chevy - Intro to Goals, Clinical Concerns, and Opportunities In Behavioral Health Managed Care
FREE COURSE AND CEU CREDIT - 1 CREDIT HOUR. This FREE course is a quick free introduction to our slide show technology and our quiz and certificate functions. It's also a free introduction to how we approach behavioral health Managed Care, and the changes which have occurred within a Health Care Reform environment (a.k.a. Managed Care).
The second half of this short course focuses upon "Understanding How Managed Care ‘Thinks’ . . . An Introduction to the Clinical Issues Which Drive the Care Management Process".
This free course is applicable to all behavioral health providers - those in private practice who are primarily interested in participating in a "panel" or network, as well as those who work for a public or private agency involved in Medicare or Medicaid or Block Grant services or other such contracts.
NOTE: If you take this FREE Course 1B, please be aware that the material is also present in some of our other Managed Care courses including FlexiCourses 4A, 5A, and 10A. What's the difference? The other courses have a lot more material and more credits!
GOALS OF COURSE 1B – ‘Intro to Goals, Clinical Concerns, and Opportunities In Behavioral Health Managed Care – It's Not Your Grandpa's Chevy’
1. Understanding the Scope and Impact of the Health Care Reform Movement Toward a Managed System of Care
2. Introduction to Clinical Concerns and Opportunities for Behavioral Health Professionals under a Managed System of Care
3. Understanding the Concept of Care Management and Utilization Review – It’s a Medical Model
4. Identify Clinical Approaches and Programs Which Are Workable and Appropriate Under a Managed System of Care
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Ethics 4D - The Ethics of Treatment Documentation and Other Ethical Dilemmas When Insurance Is Paying The Bill |
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Earn a certificate for 4 or 0.4 credits immediately upon completion of this module.
Only $28.00
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Ethics 4D - When Insurance and State Contracts Are Paying the Bill – The Ethics of Treatment Documentation and Other Ethical Dilemmas in Today’s World.
$28.00 - Four (4) Credit Hour Ethics CEUs for Professional Counselors, MFTs, Social Workers, Substance Abuse Counselors, and other behavioral health practitioners in ALMOST EVERY STATE.
Ethics 4D is a fast-paced SLIDESHOW with content that's easy to understand and never boring - regarding the ETHICAL DILEMMAS (and PRESSURES) encountered on a daily basis by those whose clients' fees are paid by insurance, managed care, or closely monitored state or local contracts.
Ethics 4D contains the same core material as the 3 credit-hour Ethics Course 3D, except that 4D includes additional material regarding these ethical issues. [Want to watch a short Ethics COURSE DEMO, with material from Ethics 4D and 3D? Click the Ethics Course Preview here.]
The first part of the course is a close-up view of that sticky issue ... what to write (and not write) in a client's treatment record, from an ETHICS perspective, in this new era of tightly controlled health care. How much do you divulge about your assessment of the client's diagnosis, his prognosis, his functional status, and his response to treatment? What's ETHICAL - when the payor is demanding details? What's NECESSARY?
In Ethics 4D we ALSO take a look at such ethical questions as the contract manager's focus upon YOUR effectiveness in the treatment process - i.e., is your approach to treatment effective (or not)? Is such scrutiny legitimate and ethical, or is it an invasion of your (and your client's) privacy? And is it ethical to provide the requested information? And .... does this emphasis upon YOUR EFFECTIVENESS have anything to do with your own ETHICAL RESPONSIBILITY, as required by your license standards? ?
LEARNING OBJECTIVES:
1. Understand the ETHICAL AND PRACTICAL impact of CARE MANAGEMENT upon WHO gets treatment, WHAT treatments they may receive, and HOW MUCH of each treatment is allowed.
2. Identify the new ETHICAL ISSUES faced by providers as a function of this new approach to authorization - i.e., JUSTIFYING and DELIVERING treatment services to our clients within this environment, and DOCUMENTING the ASSESSMENT, DIAGNOSIS, and RESPONSE TO TREATMENT.
3. Learn HOW we can ETHICALLY accommodate these new treatment and documentation requirements, while simultaneously meeting the requirements of our Provider Agreements.
4. Identify additional ETHICAL DILEMMAS encountered in treatment of mental health and substance abuse clients, including the ethics of the Quality Management - Treatment Effectiveness scrutiny which HMOs and other such contract managers place upon the work we do. Is it ETHICAL activity, or is it invasive?
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Ethics 3D - The Ethics of Treatment Documentation When Insurance Is Paying The Bill |
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Earn a certificate for 3 or 0.3 credits immediately upon completion of this module.
Only $24.00
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Ethics 3D - When Insurance and State Contracts Are Paying the Bill – The Ethics of Treatment Documentation in Today’s World.
$24.00 - Three (3) Credit Hour Ethics CEUs for Professional Counselors, MFTs, Social Workers, Substance Abuse Counselors, and other behavioral health practitioners in ALMOST EVERY STATE.
Ethics 3D is a fast-paced SLIDESHOW with content that's easy to understand and never boring - regarding the ETHICAL DILEMMAS (and PRESSURES) encountered on a daily basis by those whose clients' fees are paid by insurance, managed care, or closely monitored state or local contracts.
NOTE: Ethics 3D contains the same core material as the 4 credit-hour Ethics Course 4D, except that 4D includes additional material regarding these ethical issues. [Want to watch a short Ethics COURSE DEMO, with material from Ethics 4D and 3D? Click the Ethics Course Preview here
This course is a close-up view of that sticky issue ... what to write (and not write) in a client's treatment record, from an ETHICS perspective, in this new era of tightly controlled health care. How much do you divulge about your ASSESSMENT of the client's DIAGNOSIS(ES), his prognosis, his functional status, and his response to treatment? What's ETHICAL - when the payor is demanding details? What's NECESSARY?
Is such scrutiny legitimate and ethical, or is it an invasion of your (and your client's) privacy? And is it ethical to provide the requested information? Do your own licensure standards SUPPORT - or OVERRULE - this type of documentation of a client's treatment information?
SUMMARY OF GOALS:
1. Understand the ETHICAL AND PRACTICAL impact of CARE MANAGEMENT upon WHO gets treatment, WHAT treatments they may receive, and HOW MUCH of each treatment is allowed.
2. Identify the ETHICAL ISSUES faced by providers due to this new approach to authorization - in both the delivery of treatment services AND in the DOCUMENTATION of the ASSESSMENT, DIAGNOSIS, and TREATMENT RESPONSE.
3. Learn how we can ETHICALLY accommodate these new treatment and documentation requirements, while simultaneously meeting the requirements of our Provider Agreements.
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Course 2B - They're Coming to Audit WHEN? |
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
Only $17.50
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Course 2B - 'They're Coming to Audit WHEN?' - a.k.a, 'What Can Go WRONG in That Chart?'
$17.50 - [2 CREDIT HOURS] Want to pass that TREATMENT RECORD AUDIT? Want to avoid RECOUPMENT of claims payments already paid to you, when the MCO calls for a client's record, or their auditors show up at your door? Here's how! This fast-paced slide show clearly describes 'what's DIFFERENT' about how we must DOCUMENT TREATMENT in MH and CD/AOD client records today, under the new behavioral health contracts. And we give you useful and do-able tips on how to audit your own records - so that you are ready BEFORE the MCO or State auditor arrives. Also provides a clear explanation about HOW managed care contract administrators make pre-authorization decisions to approve or deny your requests for treatment . . . and WHAT you must write in the client's chart to support that authorization.
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Course 2C - We Have to Change WHAT? |
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
Only $17.50
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Course 2C - Intro to Professional & Clinical Issues in Managed Care - Necessary Shifts in Program Design and Treatment Approach
$17.50 - [2 Credit Hours] For Mental Health and Chemical Dependency Treatment Providers. Some of this course's material overlaps 2B material (related to managed care goals, how managed care companies THINK, and how we have to change what we write in treatment records) . . . but then the course moves ahead to include professional, clinical, and programmatic CHANGES in store for professionals who are working under a Managed Care Provider Agreement. Are you interested in this material, but want more credits than this course offers? Some of this material appears in MiniCourse 3A (3 credit hours total), and in FlexiCourse 5A (5 credit hours), and FlexiCourse 10A (10 credit hours).
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Course 3B - Addiction & Substance Abuse Treatment - 'The Big Transition' |
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Earn a certificate for 3 or 0.3 credits immediately upon completion of this module.
Only $23.00
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Course 3B - The Big Transition in the AOD Field: Assessment and Documentation of ‘Need for Treatment’ and 'Treatment Interventions' - How They've Changed!
$23.00 - [3 CREDIT HOURS] In most states, it's goodbye to flexible addiction Block Grants and other 'open access' State contracts! This course addresses the 'nitty gritty' of the major CHANGES in TRADITIONAL SA-CD PROGRAMS, TREATMENTS, DOCUMENTATION, AND PHILOSOPHY, due to the new health care environment. Applies to single AOD diagnosis and to Dual MH-AOD diagnoses.
Offers a bird's eye view of how ASSESSMENT of the client's NEED FOR TREATMENT - and HOW we DELIVER and DOCUMENT the treatment - have CHANGED under Managed Care ..... and how to constructively adapt when it's ethically possible.
SUMMARY: This course includes material on the following:
1. the BACKGROUND of why treatment approach and documentation of need for treatment have changed so significantly in the AOD field.
2. understanding how managed care contractors (such as HMOs, BHOs, MCOs, state operated plans, and commercial insurance companies) THINK about WHO needs treatment and WHAT kind of treatment they need ..... in other words, what are the new criteria for establishing the need for treatment, and how can we accommodate to it?
3. the role that treatment DOCUMENTATION plays in obtaining and maintaining treatment authorization and funding for our clients .... for example, the four KEY CONCEPTS in authorization and documentation of treatment.
4. how to design AOD treatment programs and treatment plans within the new managed care environment, which will be approved and will get the OUTCOME results that insurance carriers and state programs are looking for.
Course 3B presents some specialized treatment scenarios which can be discussed with an MCO or other care manager (State or local, etc.) which can provide effective treatment of recidivistic addiction clients, under a 'Care Management' system.
Also provides an understanding of HOW the MCOs make those controversial treatment DECISIONS for substance abusing and chemically dependent individuals - and HOW TO ASK for 'WHAT' from the MCO's care manager, to maximize your chances of getting what your clients need.
We also present clear 1-2-3 guidance on how to DOCUMENT both your assessment and the treatment you deliver under a Care Managed system - and an introduction to RECOUPMENT of funds already paid to you (which typically occurs due to inadequate DOCUMENTATION in client records). The course explains how to AUDIT your own professional documentation, so that it fits in well with the new CARE MANAGEMENT or Utilization Review (UR) process.
Some material in this course is included in MiniCourses 1B and 1C and elsewhere, but this course does it from the AOD perspective.
THE GOALS OF THIS COURSE AS THEY WILL APPEAR ON YOUR CERTIFICATE:
Course 3B – “Managing Change Within The Traditional Chemical and Substance Dependency Culture Under Managed Care: How It Affects Our Interpretation of ‘Need for Treatment’ and Our Interventions.”
1. Understanding the New Managed Care Treatment Contracts and How They Affect Us and Our Clients.
2. The Essential Clinical Shifts Imposed Upon the CD Treatment Professional and Traditional CD Programming, Under a Care Management System
3. Changing Expectations for Documentation in Treatment Records.
4. Know Some Some Workable and Creative Treatment Options Which CD Treatment Professionals May Negotiate with MCOs, Giving the Provider Greater Autonomy In Treatment Decisions.
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Course 3A - Managed Care - Is There Anything GOOD About It? |
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Earn a certificate for 3 or 0.3 credits immediately upon completion of this module.
Only $23.00
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Course 3A - Managed Care - Is There Anything GOOD About It? a.k.a., 'The Good, The Bad, and The Ugly of Providing Treatment Under Managed Care - The Perils and The Good Stuff.'
$23.00 - [3 CREDIT HOURS] All of the material in 1B and 1C is included in this course, and then we expand on the clinical opportunities and perils for providers. We attempt to put to rest the question, 'So Is there really anything GOOD about Managed Care for Mental Health and Chemical Dependency professionals?' Oh yes indeed, there is!
We take a look at what programmatic contract and treatment opportunities to pursue (and which to avoid) when you work with an HMO or other managed care administrator - what types of treatment fit with a managed care system - and how innovative, non-traditional treatment services (especially for children and adults with major mental illness) can be provided under the new managed care models for difficult high-risk clients.
The final lesson in this course focuses upon the clinical details of how Care Management departments make treatment decisions which impact your clients' recovery process, and how providers can accommodate to this shift in clinical emphasis.
NOTE: Part of the material in this course is very similar to Course 2B, and is also similar to some of the material found in MODULE 201 of FlexiCourses 4A, 5A, and 10A. Thus, if you purchase 4A, 5A, 10A, or 2B - and then decide to also purchase 3A - please do so only with this understanding.
GOALS OF THIS COURSE AS THEY APPEAR ON YOUR CERTIFICATE:
Course 3A – “Managed Care – Is There Anything GOOD About It?”
1. Intro to goals and objectives of managed care - a.k.a. 'Why are they doing this to us and our clients?'
2. The Good, The Bad, And The Ugly of managed care plans, and how to adapt your clinical approach constructively.
3. How does Managed Care (and the 'Care Management' treatment approval and review process) affect the way that we deliver treatment to Mental Health and Chemical Dependency clients?
4. Identifying some creative service options for treatment providers to explore which allow more autonomy under a ‘Care Management’ system
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Course 5B - Managed Care Contract? Survive It, Professionally! |
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Earn a certificate for 5 or 0.5 credits immediately upon completion of this module.
Only $28.00
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Course 5B - Where The Rubber Meets The Road: The Nitty Gritty of How To Have More Professional Gain and Less Pain From Those Managed Care Companies!
$28.00 - [5 CREDIT HOURS] Same as Module 401 in FlexiCourse 10A. Negotiating for good professional and clinical options and needed changes in contracts (even after the ink is dry on your basic Provider Agreement); how to collect on denied claims and dealing with HMO claims errors; and how to avoid those 'duh!' errors that can cost you dearly. When to say NO to an MCO, when to say YES, and when to say 'How about if I do THIS?' Examples of some GREAT service options to pursue with a managed care company, including CREDENTIALING flexibility.
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FlexiCourse 5A - Welcome to Care Management! Do They REALLY Need Treatment? |
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FlexiCourse 5A - Welcome to Care Management! a.k.a., 'Do They REALLY Need Treatment?'
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$28.00 - [5 CREDIT HOURS in 3 CERTIFICATES - two 2-credit hour modules, and one 1-credit hour module] The stress for today's Mental Health and AOD treatment providers can be intense, primarily because approval to provide treatment no longer rests with the provider. Coping with this fact requires a significant SHIFT in how we ASSESS a client's NEED FOR TREATMENT and in your TREATMENT APPROACH, because treatment options are more tightly controlled that ever before.
This course provides a clear view of HOW and WHY the HMOs-MCOs and other insurance companies or contract managers make those sometimes-vexing treatment authorization decisions (a process called CARE MANAGEMENT or UTILIZATION REVIEW).
Understanding these issues opens the door to obtaining AUTHORIZATION for initial and continued treatment. How do you build your case for a particular treatment option, given the tight Care Management criteria? Are there new program approaches (including step-down services and case rate packages) that your program can try, when the traditional services such as 28-day programs and Partial Hospitalization are rarely approved? Yes.
This course applies to both Mental Health and Chemical Dependency (Addiction) Treatment Providers. Included are new perspectives on documenting treatment. How to successfully play 'Mother May I?' with the Health Plan contractor. How to be maximally EFFECTIVE and avoid much frustration, through changes in PROGRAM DESIGN and TREATMENT APPROACH.
GOALS OF THIS COURSE AS THEY APPEAR ON YOUR CERTIFICATE:
Module 101: “Managed Care In Public Health Programs: It’s Not Your Grandpa’s Chevy!
1. Intro to Goals and Objectives of Behavioral Health Managed Care - 'Why Are They Doing This to Us?'
2. Understanding RISK BASED MANAGED CARE - 'Capitation' Contracts (The Primary Type Of State Managed Care Contract Including Medicaid) - And How This New Health Care System Impacts Providers In Both Clinical And Financial Ways.
3. What Can Go Wrong - At Both The MCO End And The Provider End with Delivery of Behavioral Health Services, And Within The Delivery System as a Whole?
Module 201: "The Good, The Bad, and The Ugly of Managed Care Contracts – Including Clinical and Program Options for Professionals.”
1. Continuation - Understanding the Clinical and Financial Impact of The New Healthcare
System (Managed Behavioral Health Care) Upon Providers
2. How to Adapt in Your Programs and Practices - Providing Services Under a Managed Care Provider Arrangement.
3. Several Creative Service Delivery Options
For Treatment Providers Which Will Allow the Professional To Have More Autonomy In Programming for MH and CD Clients / Patients Under a Care Management System.
4. The Four Core Elements Determining Approval for
Treatment, During the Care Management Process
MODULE 301: “Professional and Clinical Issues in Managed Care – Intro to The Necessary Shifts in Program Design, Treatment Approach Under a Level of Care System, and Documentation In Treatment Records.”
1. Understanding the impact of this new health care approach upon providers - it's called 'Care Management'!.
2. Review of 'What's a Capitation Contract' - the primary type of State-HMO managed care contract used in Medicaid and Medicare managed care conversions. Can it possibly work? Yes.
3. Understanding other Managed Care designs and their impact on patient care.
4. Review of How Managed Care (and the 'Care Management' process) affects the way that we deliver treatment to Mental Health and Chemical Dependency Clients, Through the Four Core Principles of Care Management.
5 (or 0.5) CE credits for $28.00
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This FlexiCourse 5A extracts Modules 101, 201, and 301 from our Big Managed Care Course 10A. Specifically: 5A contains both of the modules found in FlexiCourse 4A (101 and 201), and the first three modules found in FlexiCourse 10A (101, 201, and 301). Recommendation: To avoid reviewing duplicate materials, if you purchase FlexiCourse 5A, DO NOT purchase FlexiCourse 4A as you will be reviewing duplicate modules.
SUGGESTION: If you want all of the materials found in FlexiCourse 10A, you can purchase 10A .... OR you can purchase FlexiCourse 5A and Course 5B at the same time or at different times. [5B contains the materials found in Module 401 of 10A].
Also be aware that 5A contains some material also found within a few of our smaller courses, e.g., 1B, 1C, 2B, 2C, and 3A - although the concepts in these smaller courses may be presented with a bit of a different slant or with more detail - which may enrich your perspective and your absorption of these concepts!
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Module 101 - FlexiCourse 5A
Managed Care in Public Programs: It's Not Your Grandpa's Chevy!
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
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Module 201 - FlexiCourse 5A
The Good, The Bad, and The Ugly of Managed Care Contracts - Including Clinical and Program Options for Professionals
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
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Module 301 - FlexiCourse 5A
Welcome to Care Management! More On the Professional & Clinical Issues In Managed Care ..... How MCOs Make Those Treatment Decisions, and How To Deal With It.
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Earn a certificate for 1 or 0.1 credits immediately upon completion of this module.
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FlexiCourse 4A - This Is Managed Behavioral Health Care - and Its Impact on YOU! |
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FlexiCourse 4A - This Is Managed Behavioral Health Care - and It's Impact on YOU! ('The Little Managed Care Course' Modules 101 & 201)
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$26.00 - [EARNS 4 CREDIT HOURS TOTAL.] This course is presented in TWO MODULES, each earning 2 Credit Hours (and a 2-hour credit certificate). Earn both now for 4 credit hours, or save one for later, to use anytime in the next year.
What's in this course? It's a to-the-point, fast-paced ride through The Good, The Bad, and The Ugly of Managed Behavioral Health Care. An unvarnished view of WHAT HAS CHANGED for MH and CD providers with the coming of managed care, including what can go wrong in the State's design of its plans from the perspective of service delivery, and what type of Provider Agreements to avoid. It's an intro to the clinical and programmatic adjustments we must make in how we support and provide treatment services. Also presents an intro to some POSITIVE, CREATIVE ways that providers can add important clinical services to their basic contracts with insurance companies - which clearly affects the appropriateness of the treatment we provide to individual clients.
Of great significance to treatment providers, is the issue of HOW the insurance companies make decisions about approval or denial of care, i.e., Care Management. There are FOUR CORE PRINCIPLES that impact CARE MANAGEMENT decisions, and this course explains these clearly. Understanding these Core Principles of Care Management is crucial to how effectively we communicate our clients' need for treatment (verbally AND in the client's written record of treatment) including what type of treatment is needed, how much and for how long, their response to treatment, and the need for continued treatment. This course seeks to provide the understanding of these Core Principles.
NOTE: This course extracts Modules 101 and 201 from our Big Managed Care Course 10A. This course also has some of the material from Courses 1B, 1C, 3A and 5A. So if you purchase this course 4A, don't buy 1B, 1C, 3A, 5A or 10A, because some of the material would be repetitive.
GOALS OF THIS COURSE AS THEY APPEAR ON YOUR CERTIFICATE:
Module 101: “Managed Care In Public Health Programs: It’s Not Your Grandpa’s Chevy!
1. Intro to Goals and Objectives of Behavioral Health Managed Care - 'Why Are They Doing This to Us?'
2. Understanding RISK BASED MANAGED CARE - 'Capitation' Contracts (The Primary Type Of State Managed Care Contract Including Medicaid) - And How This New Health Care System Impacts Providers In Both Clinical And Financial Ways.
3. What Can Go Wrong - At Both The MCO End And The Provider End with Delivery of Behavioral Health Services, And Within The Delivery System as a Whole?
Module 201: "The Good, The Bad, and The Ugly of Managed Care Contracts – Including Clinical and Program Options for Professionals.”
1. Continuation - Understanding the Clinical and Financial Impact of The New Healthcare
System (Managed Behavioral Health Care) Upon Providers
2. How to Adapt in Your Programs and Practices - Providing Services Under a Managed Care Provider Arrangement.
3. Several Creative Service Delivery Options
For Treatment Providers Which Will Allow the Professional To Have More Autonomy In Programming for MH and CD Clients / Patients Under a Care Management System.
4. The Four Core Elements Determining Approval for
Treatment, During the Care Management Process
4 (or 0.4) CE credits for $26.00
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This FlexiCourse 4A extracts Modules 101 and 201 from our Big Managed Care Course 10A. Specifically: 4A contains the first two modules found in FlexiCourse 10A (101 and 201). To avoid reviewing duplicate materials, if you purchase FlexiCourse 10A, DO NOT purchase FlexiCourse 4A as you will be reviewing duplicate modules.
Also be aware that 4A contains some material also found within a few of our smaller courses, e.g., 1B, 1C, and 3A - although the concepts in these smaller courses may be presented with a bit of a different slant or with more detail - which may enrich your perspective and your absorption of these concepts!
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Module 101 - FlexiCourse 4A
Managed Care in Public Programs: It's Not Your Grandpa's Chevy!
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
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Module 201 - FlexiCourse 4A
The Good, The Bad, and The Ugly - Including Good and Bad Options for Providers
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
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FlexiCourse 10A - The Big Course On Managed Care For Professionals |
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FlexiCourse 10A - The Big Course On Managed Care for Professionals (Modules 101, 201, 301, & 401)
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$40.00 for 10 CREDIT HOURS. This is a 4-module FlexiCourse totaling 10 credit hours. This means that the course is comprised of 4 SEPARATE MODULES (or chapters) 101, 201, 301, and 401 - EACH of which awards 1 certificate. 101 awards 2 Credit Hours; 201 awards 2 Credit Hours; 301 awards 1 Credit Hour; and 401 awards 5 Credit Hours. Collect all 4 certificates now, or save some for later - your choice!
FlexiCourse 10A is a fast-paced slide-show course which pulls together the material found within our FlexiCourses 4A and 5A, and our Course 5B. Do NOT take Course 4A or 5A or Course 5B IF you take this course.
SO WHAT'S IN HERE? In short, a fast-paced ride through The Good, The Bad, and The Ugly of providing behavioral health services within the new managed care environment. This is NOT a business course on how to get a contract finalized with an HMO or MCO. It's an unvarnished view of what has CHANGED - professionally and programmatically - for MH and CD providers [whether they be private practitioners or employees of Community Mental Health Centers or AOD Treatment Programs] with the coming of managed care. Take a look at some some positive, CREATIVE ways that PUBLIC AND PRIVATE SECTOR providers can ADD certain cost effective program services to their basic Provider Agreements with a Care Management Company or insurance panel or your state contractor. How to deal with such contract administrators (both before and after the ink on your Agreement dries). When to say YES to the MCO. When to say NO. And when to say 'How about if I do THIS, instead?' - YES! Alternative Services are IN.
How to COLLECT YOUR MONEY when the MCO has denied a claim erroneously. Avoiding those 'duh'-type errors that cost big bucks.
Throughout the course, you will get a clear view of the primary PROFESSIONAL and CLINICAL issues -- and the necessary shifts in PROGRAM DESIGN, TREATMENT APPROACH, and PERCEPTION of WHO NEEDS WHAT TREATMENT AND FOR HOW LONG -- which we must address in order to survive these shifts in the delivery system.. NOTE: This course will give you a good idea of how the Care Management (treatment approval) process works (i.e., how HMOs-MCOs make those treatment decisions - how they THINK regarding WHO needs WHAT treatment). However, you will get more detailed information about how to translate that awareness into appropriate and effective DOCUMENTATION in clients' clinical treatment records, and how to communicate with Care Managers, in Courses 2B and 2C. In 2B and 2C you will also get very specific details regarding how to formulate clinical documentation in a manner which helps you to PASS A RECORDS AUDIT without significant issues.
NOTE: If you have NO interest in pursuing or negotiating a contract with a Managed Care Company or a commercial insurance panel, this course will probably not meet your needs. But if publicly financed programs such as Medicaid or CHIP are in [or coming to] your area of the country - or if Commercial Insurance Panels are on your agenda, and you are looking for some element of CONTROL over what you do for them - then this course is for you!
GOALS OF THIS COURSE AS THEY APPEAR ON YOUR CERTIFICATE:
Module 101: “Managed Care In Public Health Programs: It’s Not Your Grandpa’s Chevy!
1. Intro to Goals and Objectives of Behavioral Health Managed Care - 'Why Are They Doing This to Us?'
2. Understanding RISK BASED MANAGED CARE - 'Capitation' Contracts (The Primary Type Of State Managed Care Contract Including Medicaid) - And How This New Health Care System Impacts Providers In Both Clinical And Financial Ways.
3. What Can Go Wrong - At Both The MCO End And The Provider End with Delivery of Behavioral Health Services, And Within The Delivery System as a Whole?
Module 201: "The Good, The Bad, and The Ugly of Managed Care Contracts – Including Clinical and Program Options for Professionals.”
1. Continuation - Understanding the Clinical and Financial Impact of The New Healthcare
System (Managed Behavioral Health Care) Upon Providers
2. How to Adapt in Your Programs and Practices - Providing Services Under a Managed Care Provider Arrangement.
3. Several Creative Service Delivery Options
For Treatment Providers Which Will Allow the Professional To Have More Autonomy In Programming for MH and CD Clients / Patients Under a Care Management System.
4. The Four Core Elements Determining Approval for
Treatment, During the Care Management Process
MODULE 301: “Professional and Clinical Issues in Managed Care – Intro to The Necessary Shifts in Program Design, Treatment Approach Under a Level of Care System, and Documentation In Treatment Records.”
1. Understanding the impact of this new health care approach upon providers - it's called 'Care Management'!.
2. Review of 'What's a Capitation Contract' - the primary type of State-HMO managed care contract used in Medicaid and Medicare managed care conversions. Can it possibly work? Yes.
3. Understanding other Managed Care designs.
4. Review of How Managed Care (and the 'Care Management' process) affects the way that we deliver treatment to Mental Health and Chemical Dependency Clients, Through the Four Core Principles of Care Management.
MODULE 401: Course Module MC 401 'Where The Rubber Meets The Road: How to Have More Gain and Less Pain with Managed Health Care.'
1. Review of "How The Managed Care Company Thinks - What Is 'Medical Necessity of Treatment' At A Practical Level"
2. Why DOCUMENTATION in your clients' records must reflect the 'Level of Care’ decision factors.
3. How to work effectively within a MCO Care Management system and contract - how to deal with multiple issues which affect the treatment we are allowed to provide to clients and the funding we receive to do it.
4. how to AVOID making ERRORS that cause providers to lose AUTHORIZATION to provide treatment.
5. Expansion of examples of creative ways we can serve CD and MH clients under a Managed System of Care.
10 (or 1.0) CE credits for $40.00
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IMPORTANT NOTE: If you buy this FlexiCourse 10A, please be aware that the material you find here is ALSO present in FlexiCourses 4A and 5A, and in courses 3A, 1B, 1C, and 5B. Why's that? 10A is essentially a BLEND of information found in these 6 courses - the big picture about Managed Care. (See all 4 module descriptions below).
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Module 101 - FlexiCourse 10A
Managed Care in Public Programs: It's Not Your Grandpa's Chevy! Expect to read an overview of the new managed care system which answers the question, 'What in the Heck Are They Doing?'
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
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Module 201 - FlexiCourse 10A
The Good, The Bad, and The Ugly - Understanding That HMO 'Capitation' Thing, It's Impact Upon YOU. And then the FOUR CORE CLINICAL CONCEPTS That Guide Care Management Decisions - i.e., WHAT determines whether your patient gets the treatment you are requesting, or not?.
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Earn a certificate for 2 or 0.2 credits immediately upon completion of this module.
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Module 301 - FlexiCourse 10A
Playing 'Mother May I?' with the MCO. More On Care Management .... and Alternative Services. How to get OUT OF THE BOX with the managed care contractor. How to get their approval to do something different ..... something creative and effective with your clients?
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Earn a certificate for 1 or 0.1 credits immediately upon completion of this module.
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Module 401 - FlexiCourse 10A
This module 401 of the Big Course 10A, is the SAME material that's found in Course 5B - Where The Rubber Meets The Road: How To Have More Gain and Less Pain with Those Managed Care Contracts, From The Start To All The Rest. IF you want all the background on why they are doing what they are doing, and more of the clinical pieces of this puzzle, take the whole Course 10A. If that's too much to swallow all at once, jump over to Course 5B in this managed care catalog (and also 2B and 2C for a good grasp.of the clinical issues).
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Earn a certificate for 5 or 0.5 credits immediately upon completion of this module.
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Course 1C - That 'Capitation Thing' and YOU! |
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Earn a certificate for 1 or 0.1 credits immediately upon completion of this module.
Only $10.00
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Course 1C - Understanding That State or Managed Care Company 'Capitation' Thing - AND How It Impacts Providers!
$10.00 - [1 CREDIT HOUR] Some of the same introductory material as in 1B, but also explains how these managed care contracts work - i.e., should providers take on ANY of these high-risk arrangements, working as a provider for an HMO? Or as the 'substitute' for an HMO? What kind of risk are they taking? And can they succeed in any of these arrangements? (Answer: Yes.) Also, 'which' contract designs have 'which' major implications for providers.
IMPORTANT NOTE: If you buy this course 1C, please be aware that the material is also present in FlexiCourses 4A, 5A, 8A, and 10A. What's the difference? The FlexiCourses have a lot more material and more credits!
THE GOALS OF THIS PROGRAM AS THEY APPEAR ON THE CERTIFICATE:<
Course 1C - “That Capitation Thing, and YOU! How Cost Containment Affects The Way You Deliver Treatment.”
1. Understanding The Impact Of This New Health Care Approach Upon Providers and Clients - It's Called 'Care Management'!
2. Review of Risk Based Contracts – and How Providers Can Adjust Constructively.
3. Several Creative Service Delivery Approaches Which Promote Greater Autonomy In Programming For Mental Health And CD/SA Clients Providers.
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