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
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.