Healthcare Course Library for Continuing Education

Comenzando con Medicare

Proporciona una introduccion a Medicare y discute las decisiones que las personas deben tomar cuando seleccionan una opcion de Medicare. Este contenido fue desarrollado y aprobado por los Centros de Servicios de Medicare y Medicaid (CMS), la agencia federal que administra Medicare, Medicaid, el Programa de seguro M?dico para ni?os (CHIP) y el Mercado de Seguros M?dicos.

Getting Started with Medicare

Medicare is the health insurance plan administered by the Centers for Medicare and Medicaid Services (CMS) for people aged 65 and older as well as people under 65 with certain disabilities. There are 3 different enrollment periods: The Initial Enrollment Period (IEP), General Enrollment Period (GEP), and Special Enrollment Period (SEP). Medicare consists of multiple programs that cover different healthcare services. Medicare Part A covers hospitalization, Part B covers doctors visits and diagnostic tests, Part C (also known as Medicare Advantage) is a program administered by private companies that covers the same services and Medicare Parts A and B, and Part D covers prescription medications.

Coordination of Benefits

Coordination of Benefits or C O B explains the different payers responsibilities when people have both Medicare and certain other types of health and/or prescription drug coverage. This training was developed and approved by the Centers for Medicare and Medicaid Services or C M S, the federal agency that administers Medicare, Medicaid, the Childrens Health Insurance Program or CHIP, and the Health Insurance Marketplace.
The information in this training was correct as of May 2020. To check for an updated version, visit CMSnationaltrainingprogram.cms.gov.
The CMS National Training Program provides this as an informational resource for our partners. Its not a legal document or intended for press purposes. The press can contact the CMS Press Office at press@cms.hhs.gov. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.

Coordinación de Beneficios

Este modulo de capacitacion fue desarrollado y aprobado por los Centros de Servicios de Medicare y Medicaid (CMS), la agencia federal que administra Medicare, Medicaid, el Programa de Seguro M?dico para Ni?os (CHIP) y el Mercado de Seguros M?dicos facilitado por el gobierno federal.

Patient Driven Groupings Model (PDGM)

The Patient Driven Groupings Model (PDGM) is the new payment system for Medicare certified home health agencies (HHAs) that was implemented for home health periods of care on or after January 1, 2020. It is a prospective payment system with a billing cycle of 30 days (rather than 60-day previous model) and utilizes a case-mix adjustment methodology, grouping patients into payment categories based on certain patient characteristics. With the reduced billing cycle period under PDGM, physicians orders will need to be signed and received sooner than the previous payment system; both proper coding and documentation will be pertinent to the new system as well as the timeliness in submission of care plans and orders.

Pandemic Preparedness for Post-Acute Care Facilities

The term Post-Acute Care includes rehabilitation or palliative services that Medicare beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital. Depending on the intensity of care the patient requires, treatment may include a stay in a long-term care facility, assisted living, ongoing outpatient therapy, or home health care. Patients in Post-Acute Care facilities are at a higher risk of exposure and becoming infected by influenza viruses during a pandemic episode. This is due to underlying medical conditions, weakened immune systems, and the proximity to other patients and others. Contributing factors that spread viruses and other antibiotic-resistant bacteria include the ease of transmission for this patient population. A lack of consistent infection preventative measures taken by caregivers, patients, and family members can quickly turn an environment of care into a dangerous and even deadly situation. Course expiration date: 4/8/2026

Understanding and Applying CMS Regulations for Use of Restraints

Physical restraints are manual methods using a physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily, which restricts freedom of movement or normal access to one’s body. A chemical restraint is any drug used for discipline or convenience and not required for treating medical conditions. The Centers for Medicare and Medicaid Services are a part of the U.S. Department of Health and Human Services. The CMS is responsible for creating and monitoring regulations to ensure the delivery of quality healthcare in managed care systems. They also work to detect and combat fraud, waste, and abuse of the Medicare and Medicaid programs. The CMS publishes the CMS Manual System that provides the policies and procedures for hospitals and long-term care facilities. Course expiration date: 6/30/2025

Clinical Laboratory Improvement Amendments

The Centers for Medicare and Medicaid Services regulate all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). The purpose of the CLIA program is to ensure quality laboratory testing. Learning about the format, terminologies, and requirements enacted in CLIA will help you keep your laboratory in compliance. Course expiration date: 9/10/2024

CLIA Waived Ongoing Waived Testing Requirements for Influenza, Strep, Mono, HC

All laboratory facilities in the United States that perform testing on human specimens for health assessments or the diagnosis, prevention, or treatment of diseases fall under the guidance and regulatory requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Under CLIA, low-risk tests can be waived and performed with no routine regulatory oversight in physicians offices and various other locations. These waived tests include a test system, assay, or examination cleared by the Federal Drug Administration (FDA) for home use or Health and Human Services (HHS) that meets the CLIA criteria of being a simple test with an insignificant risk for an erroneous result.

These CLIA regulations require a facility to appropriately certify each waived test performed. The latest tests approved by the FDA as waived tests under CLIA can be found in the appropriately-dated versions of the Centers for Medicare and Medicaid Services (CMS) Online Manual System, New Waived Tests Transmittal, Recurring Update Notification attachments. Effective dates and descriptions are provided in these notifications for each of the latest FDA approved tests (e.g., 87502QW, May 28, 2019, Alere ID NOW Instrument {Nasal and Nasopharyngeal swabs}, for Influenza A/B). Each CLIA-approved facility recognizes that the associated Current Procedural Terminology (CPT) codes (e.g., 87502QW) indicate which newly FDA-approved tests meet waived test criteria. The Healthcare Common Procedure Coding System (HCPCS) has its own guidelines and is based on these American Medical Association CPT codes.

In this course, we cover the purpose for Recurring Update Notifications of waived tests, CPT codes for waived tests associated with these Recurring Update Notifications, and current Recurring Update Notifications for Influenza, Strep, Mono, and HCG (urine vs. serum), etc.