Course Code: REL-PAY-0-MCDGC
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2026
Learning Objectives:
Review Traditional Medicare and Medicare Parts C and D plan overviews, enrollment, and other regulations and guidelines.
Identify Medicare Parts C and D general compliance components and non-compliance violations, and how to report them.
Recall more specific Medicare compliance infringements, such as fraud, waste, and abuse (FWA) and laws and regulations for reporting and prohibiting FWA.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Traditional Medicare
Overview
Medicare Part A
Medicare Part B
Non-U.S. Citizenship Medicare Eligibility
Section 3: Medicare Part C
Overview
Medicare Part C FAQs
Medicare Part C and ESRD
Enrollment
Medicare Part C Type of Plans
Medigap
Knowledge Check Point
Section Key Takeaways
Section 4: Medicare Part D
Overview
Enrollment
Donut Hole
Knowledge Check Point
Section Key Takeaways
Section 5: General Compliance
Overview
Medicare Compliance Programs
Ethics
Code of Conduct
Knowledge Check Point
Section Key Takeaways
Section 6: Non-Compliance
Overview
Consequences of Non-Compliance
Reporting Non-Compliance
Post-Reporting and Corrections
Section 7: FWA and Relevant Laws
Overview
Fraud
Waste
Abuse
Reporting FWA
Civil False Claims Act (FCA)
Civil Monetary Penalties (CMP) Law
Health Insurance Portability and Accountability Act (HIPAA)
Knowledge Check Point
Section Key Takeaways
Section 8: Clinical Vignette
Section 9: 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: Elizabeth Vaccaro, BSN RN
Elizabeth Vaccaro earned her Bachelor of Science in nursing from Kean University. She has worked as a Multiple Sclerosis Nurse Educator. Elizabeth has worked in a variety of healthcare settings from the hospital to the pharmaceutical industry which has allowed her to have a great appreciation for all the challenges that span the healthcare field. She has practiced in the hospice setting for nine years in a variety of roles from Case Manager, Educator, and Director of both inpatient and home care hospice.
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.