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, organization determination, and appeal processes that are required in order to protect the rights of Medicare Part C enrollees. Topics in this course include: Representatives, Grievance Process, Organization Determinations, Reconsiderations, Discharge Appeals, Exceptions, Documentation and Reporting, and Education and Training. After completing this course, learners will be able to identify the definitions and regulatory requirements for processing grievances, organization determinations, and appeals including time limits, documentation, follow-up, and reporting procedures.</p><p>Instructions for handling Part D grievances, coverage determinations, and appeals are found in the course <em>Medicare Part D: Grievances, Coverage Determinations, and Appeals</em>. </p>

After this course learners will be able to identify the definitions for grievances, organization determinations, and appeals. recognize the medicare health plan’s responsibilities in the grievance and appeal processes. identify the steps that must be taken during all processes to ensure that part c enrollees’ rights are protected.