Healthcare Operations & Practice Management for Clinicians

This online enduring activity provides physicians and other clinicians with education on healthcare system operations, reimbursement structures, and practice management concepts. The program is designed to help clinicians develop and apply knowledge of healthcare operational frameworks to support effective healthcare delivery and practice management.

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Activity Information

Activity Information

Credit Hours
Up to 35 AMA PRA Category 1 Credits™
Format
Online Enduring Material
Estimated Time to Complete
Up to 35 hours
Intended Audience
Physicians, Nurse Practitioners, Physician Assistants, Nurses
Date of Original Release
April 25, 2025
Credit Expiration Date
April 30, 2026
Educational Need

Educational Need

Many physicians receive little formal training in healthcare system operations, reimbursement structures, and practice management. This activity fills those gaps, giving learners strategies to enhance clinical workflow, optimize operational processes, and improve patient care delivery.

Accreditation

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and ClinX Academy. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement: Oakstone Publishing designates this enduring material for a maximum of 35 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Non-physician participants will receive a certificate of completion. The designated AMA PRA Category 1 Credit™ may be used if accepted by their credentialing body.

Learning Objectives

Learning Objectives

After participating in this activity, learners will be able to:

  1. Analyze healthcare operational structures to identify inefficiencies that affect clinical workflow, practice management, and patient care delivery.
  2. Apply Medicare regulations and value-based reimbursement models to support regulatory compliance and sustainable healthcare operations.
  3. Evaluate revenue cycle management (RCM) best practices and develop strategies to reduce claim denials and reimbursement inefficiencies that affect healthcare operations and patient access to care.
  4. Utilize healthcare technologies to improve operational efficiency, clinical workflow, and patient engagement.
  5. Interpret payer–provider relationship models and healthcare policy frameworks to support data-driven operational decision-making.
  6. Apply workflow optimization strategies through analysis of real-world healthcare operational case studies.
  7. Integrate financial, operational, and technological considerations into decision-making to enhance healthcare delivery and the patient care experience.
Disclosure

Disclosure Information

Commercial Support
This activity did not receive commercial support.

Educational Integrity Statement
This activity is designed to provide balanced, evidence-based educational content. All planning and content development are conducted in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education.

Disclaimer
The content and views presented in this educational activity are those of the faculty and do not necessarily reflect the views of Oakstone Publishing or ClinX Academy. The information provided is intended for educational purposes and should not be interpreted as legal, financial, or regulatory advice. Participants should use their professional judgment and consult appropriate experts when applying information discussed in this activity.

Faculty & Planners

CME Faculty

AM
Alex Mohseni, MD
Founder, ClinX Academy
Cofounder, Deckdrop
AS
Amy Schiffman, MD
CEO, AgeTech Washington DC
Principal Consultant, AgingHere
DB
Donna Baldwin, D.O.
Fractional Physician Executive
Baldwin Healthcare & Finance Consulting, LLC
EB
Emily Brodkin, JD
Associate, Orrick, Herrington & Sutcliffe LLP
JS
Jeremy Sherer, J.D., LL.M.
Partner, Health Tech & Healthcare Regulatory
Orrick, Herrington & Sutcliffe LLP
KJ
Karen Joswick, MHA
President/CEO, Benevolence Health
Faculty, Thomas Jefferson University
KW
Kevin Wheeler, MD
Chief Medical Officer
Amerihealth Caritas District of Columbia
MG
Marc Gruner, DO, MBA, RMSK
Co-Founder, CMO, Limber Health
RA
Reza Alavi, MD, MHS, MBA
Principal Cofounder, Quintuple Aim
CMO, ArtiMed
Course Content

Course Content & Chapter Objectives

This activity includes 18 chapters with written and audio content. Chapter-specific objectives are listed below.

CHAPTER 01
Introduction to Medicare
  • Differentiate between Medicare Parts A, B, C, and D and their respective coverage domains
  • Identify eligibility requirements and enrollment processes for Medicare beneficiaries
  • Explain the administrative structure and funding mechanisms of Medicare
CHAPTER 02
Medicare Advantage (MA) Programs
  • Explain the structure and regulatory framework of Medicare Advantage (Part C) plans
  • Describe the benchmark setting and bid submission processes for MA plans
  • Analyze how risk adjustment affects MA plan payments and revenue
CHAPTER 03
Delegated Medical Groups and Risk Contracts
  • Define the various forms of risk contracts between payers and medical groups
  • Analyze financial responsibilities and risk-sharing arrangements in delegated models
  • Identify key metrics used for cost management in risk-bearing entities
CHAPTER 04
Managed Care, Utilization Management, and Case Management
  • Compare and contrast different managed care organizational models
  • Differentiate between utilization management and case management functions
  • Apply regulatory and compliance considerations to medical management activities
CHAPTER 05
Medicaid Programs
  • Compare state-administered Medicaid programs with Managed Care Organization (MCO) models
  • Analyze payment structures and risk management approaches in Medicaid
  • Identify funding sources and financing mechanisms for Medicaid programs
CHAPTER 06
Payment Models and Client Definitions in U.S. Healthcare
  • Describe the key characteristics of fee-for-service and value-based payment models
  • Explain the structure and operations of self-insured employer health plans
  • Differentiate between ASO and TPA arrangements
CHAPTER 07
Accountable Care Organizations (ACOs)
  • Define the structure, types, and regulatory frameworks governing ACOs
  • Analyze financial modeling and reimbursement structures within ACO arrangements
  • Compare ACOs with other advanced payment models
CHAPTER 08
Revenue Cycle Management (RCM)
  • Describe the components and workflow of healthcare revenue cycle management
  • Explain the role of medical coding and documentation in the healthcare revenue cycle
  • Analyze claims submission processes and denials management strategies
CHAPTER 09
Healthcare Payment Mechanics
  • Explain payment processing workflows in healthcare settings
  • Describe payer contracting and negotiation processes
  • Analyze claims adjudication and reimbursement mechanisms
CHAPTER 10
Payer Enrollment and Credentialing
  • Describe the payer enrollment and credentialing process for healthcare providers
  • Explain the role of CAQH, PECOS, and other credentialing databases
  • Identify common challenges and timelines in enrollment processes
CHAPTER 11
Medicare and Payer Audits
  • Identify the types of audits conducted by Medicare and commercial payers
  • Describe common audit triggers and the audit process methodology
  • Develop compliance strategies to mitigate audit risk
CHAPTER 12
Medicare Telemedicine, Remote Care, and In-Home Care
  • Describe Medicare payment models for telehealth and virtual care services
  • Differentiate between Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM)
  • Explain coding and documentation requirements associated with remote and virtual care services
CHAPTER 13
CPOM, Friendly PC Ownership, and MSO Structures
  • Explain the Corporate Practice of Medicine (CPOM) doctrine and its state variations
  • Describe friendly PC ownership structures and their legal considerations
  • Analyze Management Services Organization (MSO) arrangements
CHAPTER 14
Concierge Medicine
  • Define concierge medicine models and their historical development
  • Describe the regulatory framework governing concierge and direct primary care practices
  • Analyze operational and business model considerations for concierge practices
CHAPTER 15
Collaborating Physician Arrangements
  • Identify the types of collaborating physician arrangements and their legal requirements
  • Describe the responsibilities and scope of practice for collaborating physicians
  • Analyze financial and contractual aspects of collaboration agreements
CHAPTER 16
Health Data Interoperability and Standards
  • Describe key healthcare data interoperability standards including HL7 and FHIR
  • Explain regulatory and policy frameworks affecting health information exchange
  • Identify challenges and emerging trends in health information technology
CHAPTER 17
Automation and AI in Healthcare
  • Describe applications of predictive analytics for clinical and operational improvement
  • Evaluate AI-driven clinical decision support systems and their implementation
  • Explain robotic process automation applications in healthcare operations
CHAPTER 18
Key Federal Health Care Laws and Regulations
  • Explain the Physician Self-Referral Law (Stark Law) and its exceptions
  • Describe the Anti-Kickback Statute and safe harbor provisions
  • Analyze the False Claims Act and apply HIPAA requirements to healthcare operations
How to Participate

How to Participate / Claim Credit

To receive AMA PRA Category 1 Credit™:

  1. Review the learning objectives for each chapter
  2. Complete the educational content (written and audio chapters)
  3. Pass the post-test with a minimum score of 75%
  4. Submit the evaluation form before the expiration date
Contact

Contact Information

For questions regarding this activity, contact:

ClinX Academy LLC
Email: cme@clinxacademy.com

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Earn up to 35 hours of AMA PRA Category 1 Credits™

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