Medicare Advantage

  1. After completing this course, you will be able to identify the principles and motivation for risk adjusting the capitation payments CMS makes to Medicare Advantage (MA) plans. You will also be able to identify the components of the risk adjustment process, the requirements for data collection, and the process for submitting that data to CMS. Finally, you will be able to recognize the... Learn More...
    $24.95
    45 min
    Lesson
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  2. This course examines what types of marketing materials are regulated, what must be included in the materials and what is prohibited, how the CMS approval process works, the parameters of promotional marketing to beneficiaries, and what role providers and pharmacies are permitted to play in marketing a sponsor’s plan.
    $24.95
    45 min
    Lesson
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  3. This course focuses on the concepts behind Utilization Management in the Medicare Advantage Organization, including topics such as coordination of care across all providers and services as well as case management. Throughout this presentation, learners are introduced to new developments in Medicare brought about by regulations such as the Medicare Prescription Drug, Improvement, and... Learn More...
    $24.95
    60 min
    Lesson
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  4. This course addresses fraud, waste and abuse laws, regulations, and guidelines that apply to Medicare health plans and Prescription Drug Plans (PDP) also referred to as plan sponsors. It presents information on the False Claims Act, the Federal Anti-Kickback Statute, the Beneficiary Inducement Statute, and the Stark Law. After completing this course, learners will recognize the increased... Learn More...
    $24.95
    45 min
    Lesson
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  5. This course explains the benefits available to individuals who are eligible for Part D, and presents the requirements for bidding to become a plan sponsor. After completing this course, learners will be able to recognize the benefits offered under both standard and alternative prescription drug coverage. Learners will also be able to identify the requirements for successful bidding, and... Learn More...
    $24.95
    90 min
    Lesson
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  6. This course examines the procedures required by the Centers for Medicare and Medicaid Services (CMS) that Part D sponsors (MAPDs and PDPs) must follow when coordinating benefits with other providers of prescription drug coverage. The course also discusses the Part D true out-of-pocket (TrOOP) facilitation process.
    $24.95
    45 min
    Lesson
    Add to Cart
  7. Part D sponsors must develop a network of pharmacies so beneficiaries have “convenient” access to drugs covered under Part D. After completing this course, learners will be able to identify the types of pharmacies that can be included in a network as well as the requirements Part D sponsors must meet to contract with pharmacies and create a pharmacy network.
    $24.95
    60 min
    Lesson
    Add to Cart
  8. This course identifies primary cost control provisions in detail, including drug utilization management (UM) and medication therapy management programs (MTMPs). This course also identifies the quality assurance requirements applicable to Part D sponsors and introduces participants to CMS’s electronic prescribing program.
    $24.95
    60 min
    Lesson
    Add to Cart
  9. This course is intended to instruct you on the Quality Improvement regulatory requirements for a Medicare Advantage Organization (MAO). It will also discuss the implementation of a Quality Improvement program. Utilization Management in a MAO is discussed, including topics such as coordination of care across all providers and services as well as case management.
    $24.95
    60 min
    Lesson
    Add to Cart
  10. This course is intended to instruct you on the critical issues of quality management in a Medicare Advantage Organization. This course is the first in a two-part series and should be viewed in conjunction with its associated presentation. The second course is Medicare Advantage: Quality Management Program Implementation.
    $24.95
    30 min
    Lesson
    Add to Cart

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