CMS Training: Medicare Rights and Protections

CMS Training: Medicare Rights and Protections 

“Medicare Rights and Protections,” explains the rights and protections afforded to you whether you’re enrolled in Original Medicare, a Medicare Advantage Plan (like a Health Maintenance Organization or Preferred Provider Organization), and other Medicare health plan (like a Medicare Cost Plan or Program of All-Inclusive Care for the Elderly), or a Medicare Prescription Drug Plan. This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federally-facilitated Health Insurance Marketplace and is brought to you by Relias Learning. The information in this module was correct as of May 2016. To check for an updated version, visit education/training/cmsnationaltrainingprogram/index.html. The CMS National Training Program provides this as an informational resource for our partners. It’s not a legal document or intended for press purposes. The press can contact the CMS Press Office at [email protected] Official Medicare program legal guidance is contained in the relevant statutes, regulations, and rulings.


Hours: 3.00


Certificates provided by accrediting body (0 Match)

Course Details

Course Code: REL-PI-0-P75
Hours: 3
Type: Online Course
Content Expiration Date: 5/31/2022
Learning Objectives:
Explain Medicare rights and protections.
Recognize rights in certain healthcare settings.
Summarize Medicare privacy practices.
Locate additional information and resources.

Section 1: Introduction A. About This Course B. Learning Objectives Section 2: Medicare Rights A. Your Medicare Rights B. Medicare and Your Information Rights C. Medicare Rights and Access to Care D. Medicare Rights: Claims and Appeals E. Medicare Grievance Rights F. Family Centered Care (BFCC)-Quality Improvement Organizations (QIO) Service Area Maps G. Your Rights in Original Medicare H. Appeal Rights in Original Medicare I. How to Appeal in Original Medicare J. Fast Appeals in Original Medicare K. Original Medicare Appeals Process L. Types of Liability Notices for People with Original Medicare M. Original Medicare Protection from Unexpected Bills N. Medigap Rights in Original Medicare O. Your Rights in Medicare Advantage and Other Medicare Health Plans P. Coverage and Appeal Rights in Medicare Health Plans Q. Medicare Part C Appeals Process R. Rights When Filing Medicare Health Plan Appeals S. Medicare Prescription Drug Coverage (Part D) Rights-Access to Covered Drugs T. Required Coverage: Part D U. Formulary V. Request a Part D Coverage Determination W. Rules That Plans Use to Manage Access to Drugs X. When Plan’s Must Grant Formulary Exceptions Y. Requesting Part D Appeals Z. Medicare Part D Levels of Appeal AA. Required Part D Notices BB. Provider/Plan Disclosure of Personal Health Information (PHI) CC. To Whom Plans May Disclose Personal Health Information (PHI) DD. Review EE. Summary Section 3: Your Rights in Certain Settings A. Right to Hospital Care B. “Important Message from Medicare” C. Rights in a Skilled Nursing Facility D. Rights in Home Health and Hospice E. Rights in Other Settings-Comprehensive Outpatient Rehab Facility (CORF) F. Fast Appeals Process G. Review H. Summary Section 4: Medicare Privacy Practices A. “Notice of Privacy Practices” B. Required Disclosures C. Permitted Disclosures D. Permitted Disclosures (Continued) E. Personal Medical Information Authorization F. Personal Medical Information Privacy Rights G. If Privacy Rights Are Violated H. Review I. Summary Section 5: “Medicare Rights and Protections Resources” A. Advance Directives B. Who is the Medicare Beneficiary Ombudsman? C. Review D. Summary E. Appendix A F. Appendix B G. Appendix C: Appointment of Representative Form Instructions Section 6: Conclusion A. Summary B. Course Contributor C. Resources

Instructor: Centers for Medicare & Medicaid Services National Training Program
The core components of this training module were developed and approved by the Centers for Medicare & Medicaid Services National Training Program (NTP). The original CMS content was enhanced with the addition of interactive vignettes, brought to you by Relias Learning. Disclosure: Centers for Medicare & Medicaid Services National Training Program has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: General Staff; in the following settings: All Healthcare Settings.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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