Course Catalog
Health Law Seminar: Medicare and Medicaid Fundamentals-provider Regulation and Reimbursement Seminar (3)
This seminar will examine the Medicare and Medicaid systems and the regulation of health care providers participating in those programs. The course will provide an overview of Medicare, Medicaid, and the administrative law framework for governmental decisions. Additionally, each major provider type will be examined (e.g., hospitals, long term care facilities, home health care providers, hospices, and physicians) including the regulations specific to each. In all cases, both the reimbursement structure and legal requirements for participation in the program will be discussed. Finally, the seminar will cover recent developments and trends in the law and policies that affect public payers. Student presentations, possibly in group format, may be required in addition to a seminar paper. Topics to be covered include:
- Fundamentals of Medicare and Medicaid Regulation of Health Care Providers (Part A and Part B)
- Principles of Coverage, Coding, and Payment
- Medicare Contractors and State Medicaid Agencies
- Prospective Payment Systems
- Regulations Specific to Certain Types of Providers (e.g., Hospice benefit, physician and physician fee schedule, etc.)
- Appeals of Individual Claims/Cost Reports and Local/National Coverage Policies
- Program Integrity (fraud and abuse)
- Emerging Prescription Drug Benefit
- Coverage of New Technologies
- Impact of Governmental Programs on Private Payers
- Governmental Cost Containment Efforts
Current & Previous Instructors:
| This course is not currently scheduled. |
Key to Codes in Course Descriptions
P: PrerequisiteC: Prerequisite or Concurrent Requirement
R: Recommended Prior or Concurrent Course
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