Healthcare Course Library for Continuing Education

Code of Conduct for Medicare

The course provides the conceptual framework of important considerations for establishing and maintaining a Code of Conduct and how it compliments and reinforces an organizations Compliance Program. The essential elements of a Compliance Program such as written policies and procedures, compliance programs, compliance committees, establishing a code of conduct, audits, consistent discipline, and corrective action. Real-life scenarios will be presented to help you understand how the Code of Conduct is used in the workplace.

Introduction to Fraud, Waste, and Abuse

Course overview
This course provides a basic overview of the Medicare program and orients the learner to instances of fraud and abuse in how Medicare is managed in relation to the role of healthcare providers. The course provides case examples to help learners examine the practical implications of fraud, waste and abuse in Medicare, discusses existing mechanisms for prevention, and reviews processes for reporting wrong-doing. This course must be taken in combination with the web-based CMS training ??ombating Medicare Parts C and D Fraud, Waste, and Abuse??to ensure full compliance with requirements for providers participating in the Medicare Program.
Goal
This course orients learners to basic concepts of Fraud, Waste and Abuse, and identifies key actors in ensuring compliance with federal regulations concerning the Medicare program.

Stark Law and Anti-Kickback Statute

Course overview
Stark Laws, along with Anti-Kickback Statutes are complex and often require individuals and entities to seek legal advice to avoid even the appearance of wrongdoing. The Social Security Act under Section 1877 is known as the physician self-referral law and commonly referred to as the Stark Law. The course provides an overview of Stark Law that prohibits a physician from referring Medicare patients to an entity with which the physician (or immediate family member) has a financial relationship, and prohibits the designated health services entity from submitting claims to Medicare for prohibited referral services. Learners will also review the foundational principles of the law, examples of cases in which exemptions may apply, and recent changes to this evolving regulation.
Goal
This is designed to equip participating Medicare and Medicaid Program providers with knowledge of the foundational principles of Stark Laws and the Anti Kickback Statute.

The Medicare Access and Chip Reauthorization Act of 2015

On April 27, 2016, the Department of Health and Human Services issued a Notice of Proposed Rulemaking to implement key provisions of the Medicare Access and CHIP Reauthorization Act of 2015. This course will cover the quality payment program of this act and examine what a quality payment program is, how to submit comments on proposed rules, merit-based incentive payment systems, and incentives in participating in advanced alternative payments.

Medicare Rights and Protections

This course was developed and approved by the Centers for Medicare and Medicaid Services (CMS), the Federal agency that administers Medicare, Medicaid, and the Childrens Health Insurance Program (CHIP) and the Health Insurance Marketplace. This course explains the rights and protections afforded to someone enrolled in Original Medicare, a Medicare Advantage Plan, another Medicare health plan, or a Medicare Prescription Drug Plan.

The Patient Centered Medical Home: Principles and Recognition Process

The patient centered medical home (PCMH) model has become a cornerstone of primary care redesign. While the concept of the medical home was first introduced for pediatric settings by the American Academy of Pediatrics in 1967, the major primary care physician associations developed and endorsed the joint principles of the PCMH in 2007. Since then, the PCMH concept has become increasingly important as Medicare, Medicaid agencies, health plans, and other payers seek to improve the quality of care they purchase and control their costs. Based on recent information collected by the Patient-Centered Primary Care Collaborative (PCPCC), there are nearly 500 public and private medical home initiatives across the United States. Payers and others are working to gather evidence of the effects of different approaches to implementing the medical home model, so the model can be refined and adapted to the varied needs of patients, practices, and regions.

This course will provide information and resources for working with practices as they seek and attain PCMH recognition, which is the process through which a practice achieves its status as a medical home. This process is also sometimes referred to as accreditation or certification. Understanding the principles of the PCMH will help you support practices through the recognition process while ensuring that the objectives of true practice transformation to a PCMH do not get lost as practices document the processes needed to achieve PCMH status.

Medicaid y el Programa de Seguro Médico para Niños (CHIP)

Este curso fue desarrollado y aprobado por los Centros de Servicios de Medicare y Medicaid (CMS), la agencia federal que administra Medicare, Medicaid y el Programa de Seguro M?dico para Ni?os (CHIP) y el Mercado de Seguros M?dicos. Este curso proporciona una vision general de las consideraciones de Medicaid, Medicaid y Medicare (doblemente elegibles), la vision general de CHIP, y la elegibilidad de los no ciudadanos en Medicaid y CHIP.

Medicare Advantage y otros planes de salud Medicare

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. MA Plans, sometimes called Part C or MA Plans are offered by Medicare-approved private companies that must follow rules set by Medicare.
If an individual joins an MA Plan, he or she will still have Medicare but get most of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the MA Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D).
In most cases, individuals will need to use health care providers who participate in the plans network. However, many plans offer out-of-network coverage, but usually at a higher cost.

This course provides basic information about Medicare health plan options other than Original Medicare.

Medicare para personas con Enfermedad Renal en Etapa Terminal (ERET)

This course was developed and approved by the Centers for Medicare and Medicaid Services (CMS), the Federal agency that administers Medicare, Medicaid, and the Childrens Health Insurance Program (CHIP) and the Health Insurance Marketplace. This course provides basic information about End-Stage Renal Disease (ESRD) and Medicare eligibility, Medicare enrollment based on ESRD, what Medicare covers, coverage options for people with ESRD, and additional sources to learn more.