Essentials of Medicare and Medicaid Managed Care

This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recent changes in the law affecting Medicare managed care contracting. This course also identifies the rights and responsibilities of Medicare enrollees. It also provides an overview of the Medicare Part D pharmacy benefit and points out some successes and failures of Medicaid managed care.

Learning Objectives:

After this program, you’ll be able to:

• Provide an overview of Medicare and its history
• Recognize how the Centers for Medicare and Medicaid Services (CMS), the Federal Trade Commission (FTC), the Internal Revenue Service (IRS), the Office of the Inspector General (OIG), the Department of Justice (DOJ), the Securities and Exchange Commission (SEC), and the U.S. Public Health Service administer and regulate Medicare
• Define the Inpatient Prospective Payment System
• Recognize the Outpatient Medicare Prospective Payment System
• Recognize how Medicare provides payment to physicians
• Recognize relevant legislative changes affecting Medicare managed care
• Recognize demonstration projects
• Recognize examples of these projects
• Identify key elements of ABNs
• Identify the rights and responsibilities of Medicare enrollees
• Recognize the features of Medicare Part D
• Identify how healthcare providers are paid under Medicaid
• Recognize successes and failures of Medicaid managed care

Estimated course completion time: 1 hour

General Program Information