Medicare Part D: Bid and Benefit Package

Recognize the benefits offered under both standard and alternative prescription drug coverage. Identify the requirements for successful bidding. ...

Medicare Advantage: Administration and Management

Recognize the critical role of management in operating an MAO. Identify the basic administrative infrastructure necessary to do business with CMS in ...

Medicare Advantage: Membership Services

Identify the functions of Member Services in a Medicare Advantage Organization. Recognize CMS regulatory requirements related to Member Services. ...

Medicare Advantage: Claims Processing

Differentiate between contracted and non-contracted providers and how claims should be processed using the reimbursement methodologies as set forth ...

Medicare Advantage: Provider Networks

Recognize tools that may be used to develop and validate provider networks. Recognize the usefulness of “model” contract provisions and checklists. ...

Medicare Advantage: Quality Management and Utilization Management

Identify the basics of QI program implementation. Identify the standards of a QI program. Recognize the processes and requirements for conducting ...

MAPD/PDP: Marketing

Identify the marketing materials that are regulated by CMS, the information that must be included in the materials, and how the CMS approval process ...

MAO/PDP: Compliance Program Guidelines

Recognize the requirements for implementation of an effective compliance program.

Special Needs Plans: Model of Care

Identify the required elements of a Special Needs Plan’s Model of Care as well as the scoring criteria that are used as part of the review and ...

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

Recognize CMS’ process for coordinating prescription drug benefits among payers. Recognize the requirement for calculating and maintaining accurate ...

Access to Employee Exposure and Medical Records

Identify what information can be found in medical and exposure records. Recognize where these records are located. Identify who is responsible for ...

Process Safety Management: Overview

Recognize what Process Safety Management (PSM) is and who it covers. Recognize the components of PSM. Identify the importance of employee ...

MAPD: Risk Adjustment and Data Validation

Identify the principles and motivation for risk adjustment. Identify the components of the risk adjustment process. Recognize the requirements for ...

Information Security

Recognize the security policies, procedures, and controls that are part of our daily business routine. Identify suspected security breaches and how ...

Deficit Reduction Act: False Claims and Employee Protections Training

Recognize what the federal False Claims Act is and how it pertains to fraud and abuse in Medicaid programs. Identify the provisions for protection ...

HP: Compliance Program General Session

Identify the reasons for implementing a Compliance Program. Identify the seven essential elements that make up an effective Compliance Program. ...

Fraud and Abuse Awareness

Identify the most common types of fraud and abuse. Recognize the negative effects that fraud and abuse have on the healthcare business and its ...

Code of Conduct

Recognize the standards of conduct outlined in the Code. Identify how these principles apply to the types of activities you must perform on a daily ...

HIPAA: General Awareness

Identify the goals of HIPAA and its Administrative Simplification provisions. Identify the entities that are covered under the law and recognize how ...

HIPAA: Privacy Standards

Recognize the rules governing the use and disclosure of protected health information (PHI). Identify when an individual’s permission is required ...

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

Identify fraud, waste, and abuse risk areas and related laws, regulations, and guidelines that apply to Medicare managed care. Recognize how to ...

Medicare Advantage: Provider Compliance

Identify the responsibilities of providers who contract with Medicare Advantage Organizations (MAOs) to deliver healthcare services to Medicare ...

Medicare Advantage: Grievances, Organization Determinations, and Appeals

Identify the definitions for grievances, organization determinations, and appeals. Recognize the Medicare health plan’s responsibilities in the ...

Business Practices to Protect Personal Health Information

Recognize the basics of our privacy and security practices. Recognize your roles and responsibilities related to health information.

MAPD: Enrollment

Identify the beneficiary eligibility criteria for Medicare Advantage plan enrollment. Identify the key concepts, principles, and the Medicare ...

Medicare Part D: Medication Therapy Management and Quality Improvement Program

Identify the primary cost control provisions. Identify the quality assurance requirements applicable to Part D sponsors. Identify processes CMS has ...

Medicare Advantage: Overview of the Medicare Program

Recognize the purpose of Medicare. Identify the primary Medicare coverage options and their requirements. Recognize the role of the Federal ...