Explaining HPA 2022: Utilization Management (UM)

October 14, 2021

Cost: $330

Explaining HPA 2022: Utilization Management (UM)

This live course is a thorough examination of the HPA standards for Utilization Management (UM).  Faculty will give participants guidance for interpreting the requirements, navigating the standards and avoiding misconceptions, and will facilitate brief activities that simulate addressing requirements. This course is appropriate for all professionals with a direct or indirect stake in NCQA Accreditation.

This course presents information based on HPA 2022 standard requirements and its contents apply directly to NCQA Accreditation Surveys conducted between July 1, 2022, and June 30, 2023. For  courses pertaining to Delegation requirements, use “Delegation” to search NCQA courses at ncqa.org/education. 

Group Training?

To inquire about group training rates, complete our online form.

Key Topics

  • Controlling UM systems.
  •  Handling member appeals.
  •  Determining coverage and medical necessity.
  •  Administering denial notices.
  •  Improving survey readiness and performance

Benefits and Resources

  •    Presentation slides.
  •    Recording of live session.
  •    Live Q&A.
  •    Scenarios for applied learning.
  •    NCQA surveyor’s perspective of the standards.
  •    ACCME Credits for clinicians.
     

Target Audience

  •  Clinicians, directors, managers, specialists and coordinators.
  •  Consultants, contractors, delegates and vendors.
  •  Health plans and managed care organizations.
  •  Professionals in compliance, risk management or public policy.
  •  Professionals in population health or public health.
  •  Professionals in quality assurance/improvement or performance management.

Learning Objectives

  •  Explain the intent of the HPA UM standards.
  •  Define performance issues and target results within the scope of requirements.
  • Describe relationships and themes across the UM elements.
  • Discuss requirement implications and considerations for stakeholders.
  • Critique examples and scenarios to enhance application.
Course summary
Available credit: 
  • 3.00 AAPA
  • 3.00 ACPE
  • 3.00 AMA PRA Category 1 Credit™
  • 3.00 ANCC
  • 3.00 APA
  • 3.00 ASWB
  • 3.00 IPCE
  • 1.00 Participation
  • 2.00 PCMH CCE
Course opens: 
06/01/2021
Course expires: 
12/31/2021
Event starts: 
10/14/2021 - 1:00pm
Event ends: 
10/14/2021 - 4:00pm
Cost:
$330.00

Clint Koenig, MD, MSPH, MA

Clint Koenig, MD, MA, MSPH is the senior Medical Director at Ohio Healthy, a new system-based health plan in Columbus Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse New York as well as the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems.

He has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long Term Services and Supports organizations.

Dr. Koenig received his MD from Albany Medical College in Albany, NY. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received Masters degrees in Public Health and Journalism.

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In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC), the American Academy of Physician Assistants (AAPA), the American Psychological Association (APA), and the Association of Social Work Boards (ASWB) to provide Interprofessional Continuing Education for the healthcare team. 

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, ANA CNE, APA, ACPE and ASWB ACE.

The assigned universal program number: JA0004597-0000-21-010-L04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours. 

Available Credit

  • 3.00 AAPA
  • 3.00 ACPE
  • 3.00 AMA PRA Category 1 Credit™
  • 3.00 ANCC
  • 3.00 APA
  • 3.00 ASWB
  • 3.00 IPCE
  • 1.00 Participation
  • 2.00 PCMH CCE

Price

Cost:
$330.00
Please login or register to take this course.

Required Hardware/software

We recommend using either Google Chrome or Mozilla Firefox as your browser for the optimal experience with the NCQA Education learning management system.