Course Code: REL-PAY-0-MAOMP
Hours: 1.5
Type: Online Course
Content Expiration Date: 12/31/2025
Learning Objectives:
Recall the overarching concept, eligibility, and enrollment guidelines for MA and Traditional Medicare.
Identify the types of MA and other Medicare plans.
Recognize government oversight and regulations of MA as well as beneficiary rights and protections.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Medicare and MA Overview
Current Problem and Gap Analysis
Meet Evelyn
Traditional Medicare
MA
MA FAQs
MA and ESRD
Knowledge Check
Key Takeaways
Section 3: Eligibility, Cost, and Enrollment
Overview
Citizenship and Other Eligibility Criteria
Cost
MA Plan Enrollment
Medigap
Knowledge Check
Key Takeaways
Section 4: Types of MA and Medicare Plans
Overview
Choosing a MA Plan
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plan
Special Needs Plans (SNPs)
Medical Savings Account (MSA) Plans
Program of All-Inclusive Care for the Elderly (PACE) Plans
Knowledge Check
Key Takeaways
Section 5: Government Oversight and Regulation
Communication and Marketing Materials
General Rules
General Marketing Requirements
Beneficiary Contact
Websites
Plan Information Disclosure
Disclaimers
Agent/Broker Requirements
Marketing in Healthcare Settings
Educational Events
Promotional Activities, Rewards, and Incentives
Knowledge Check
Key Takeaways
Section 6: Beneficiary Rights and Protections
Guaranteed Rights
MA Plan Rights
MA Plan Appeals Process
Knowledge Check
Key Takeaways
Section 7: Clinical Vignette
Section 8: Conclusion
Course Summary
Course Contributors
Resources
References
Subject Matter Expert: Shalla Newton, MSN, RN, NE-BC
Shalla is a subject matter expert (SME)/writer for Relias. She completed her BSN and two undergraduate degrees with top honors from the University of Wisconsin-Madison. Shalla earned her dual MSN degrees from Johns Hopkins University with top honors. She also maintains her post-baccalaureate nurse educator certificate (NE-BC). Shalla’s tenure spans over 20 years of cross-functional leadership and direct clinical roles in healthcare, biopharma/biotech, government affairs, managed care/market access, nonprofit patient advocacy, and research. Her subject matter expertise is in rare, orphan, and complex diseases. Her sub-expertise is in immune-mediated diseases (rheumatology and immunology), genetics, neurology, hematology/oncology, several pediatric diseases, population/public health, and larger systemic healthcare affairs. Shalla is a published author with leading rare disease experts and a global speaker. She also sits on scientific, advocacy, and legislative advisory boards. She has led national advocacy and disease awareness campaigns, including speaking before congress, leading to the first-in-class rare disease biologic approval and investigative treatment protocols.
Subject Matter Expert: Alissa Hershberger, MSN, RN, CCRN, CNE
Alissa is an external SME contracted with Relias. She completed her first bachelor’s degree in general science at Middle Tennessee State University and her BSN at Loyola University Chicago. Alissa earned her MSN in nursing education from the University of Central Missouri, where she currently works as a professor in the critical care nursing department. Alissa’s previous tenure includes working as a clinical coordinator for home health where she used her knowledge of government reimbursement models and Medicare billing practices to effectively coordinate patient care.
Target Audience:
The target audience for this course is: Nurses; Physicians; in the following settings: Acute Care Facility.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.