Medicare Part D: Bid and Benefit Package

<p>This course explains the benefits available to individuals who are eligible for Part D and presents the requirements for bidding to become ...

Section 1557 of the Affordable Care Act

This course discusses the requirements of Section 1557 of the Affordable Care Act. After completing this course, learners will be able to identify ...

Medicare Advantage: Administration and Management

This course provides information on the administrative infrastructure and management capabilities required of all Medicare Advantage Organizations ...

Medicare Advantage: Membership Services

<p><span style="font-weight:normal;">This course discusses the obligations of a Medicare Advantage Organization (MAO) and of the Centers ...

Medicare Advantage: Claims Processing

<p>This course explores the Centers for Medicare and Medicaid Services (CMS) regulations and instructions for the processing of Part C ...

Medicare Advantage: Provider Networks

<p>This course examines provider networks and the tools associated with their development. It includes an in-depth look at tools that are ...

Medicare Advantage: Quality Management and Utilization Management

<p>This course describes the Quality Improvement (QI) regulatory requirements for a Medicare Advantage Organization (MAO). Topics in this ...

MAPD/PDP: Communications and Marketing

<p>This course examines what types of communication materials are regulated, what must be included in the materials and what is prohibited, ...

MAO/PDP: Compliance Program Guidelines

Effective compliance programs are a requirement for Medicare Advantage Organizations (MAO) and Medicare Prescription Drug Plans (PDP) that contract ...

Special Needs Plans: Model of Care

The Model of Care (MOC) is considered a vital quality improvement tool and integral component for ensuring that the unique needs of each beneficiary ...

Medicare Part D: Coordination of Benefits and True Out-of-Pocket Facilitation

<p><span>This course examines the procedures required by the Centers for Medicare and Medicaid Services (CMS) that Part D sponsors ...

Access to Employee Exposure and Medical Records

Employers must keep medical or exposure records for all employees who have been exposed to a hazardous substance in the workplace. This course ...

Process Safety Management: Overview

Unexpected releases of toxic, reactive, and flammable liquids and gases have caused great harm and numerous deaths. Such events underscore the need ...

MAPD: Risk Adjustment and Data Validation

<p>This course identifies the principles and motivation for risk adjustment of capitation payments that the Centers for Medicare &amp; ...

Information Security

Information security is critical for any business, and it is the law for healthcare organizations. This course addresses training on the HIPAA ...

Deficit Reduction Act: False Claims and Employee Protections Training

This course covers the Deficit Reduction Act of 2005 (DRA) and provides awareness of the mandates and provisions that must be provided to employees ...

HP: Compliance Program General Session

The Office of Inspector General (OIG) guidance promotes Compliance Programs for all healthcare organizations. This course is designed to fulfill the ...

Fraud and Abuse Awareness

<p>Fighting fraud and abuse within a health plan is important, and associates are valuable assets in anti-fraud efforts. This course describes ...

Code of Conduct

Trust is the cornerstone of any long-term business relationship. Our responsibility is to earn that trust every day by acting in an ethically and ...

HIPAA: General Awareness

This course is designed to provide all employees and associates with an in-depth overview of the Health Insurance Portability and Accountability Act ...

HIPAA: Privacy Standards

Health plan members must be able to trust that shared information will be protected and remain confidential. This course provides an in-depth look at ...

Medicare Health Plan and PDP: Fraud, Waste, and Abuse

<p>Healthcare fraud, waste, and abuse are considered a top priority to the US government, second only to terrorism and violent crime. This ...

Medicare Advantage: Provider Compliance

<p>This course reviews requirements every provider must adhere to, including specific rights and responsibilities, and elements contained in ...

Medicare Advantage: Grievances, Organization Determinations, and Appeals

<p>The Medicare Part C program provides coverage for medical benefits for eligible Medicare beneficiaries. This course describes the grievance, ...

Business Practices to Protect Personal Health Information

This course provides all employees and associates with knowledge of the privacy and security practices for health plans, as required by the Health ...

MAPD: Enrollment

<p>To ensure proper member enrollment, specific standards must be maintained. This course describes processes and procedures for enrollment for ...

Medicare Part D: Medication Therapy Management and Quality Improvement Program

<p>This course identifies primary cost control provisions in detail, including drug utilization management (UM) and medication therapy ...

MAPD: Disenrollment

To ensure proper member disenrollment, specific standards must be maintained. This course describes processes and procedures for disenrollment from ...

Medicare Advantage: Overview of the Medicare Program

This course provides an overview of the Medicare Program including what it is, how it is implemented, and how government regulations influence it. ...