Ch.9 Compliance Program | PSyn Courses

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Managed Care Courses--Medicare Premium

Welcome

Welcome to PSyn Courses

Managed Care 101

Overview and History of Managed Care (4:50)
Acronyms and Definitions
Types of Insurance (12:55)
Pharmacy Networks and Pricing (12:20)
PBMs & Revenue Streams (4:47)
Intro to Managed Care Quiz

Medicare 101

Medicare History (2:05)
Medicare Benefits and Coverage (6:03)
Medicare Enrollment (5:20)
Medicare Supplement Plans (4:23)
Part D Coverage Stages (27:01)
Medicare Plan Finder (45:31)
Low Income Subsidy (LIS) (7:52)
Employer Group Waiver Plans (EGWP) (2:19)
Medicare 101 Quiz

Medicare Guidance

Medicare Guidance Overview (1:40)
Ch.9 Compliance Program (2:58)
Ch.6 Part D Drugs and Formulary Requirements (16:46)
Ch.7 Medication Therapy Management Program (MTMP) (3:09)
CDAG Guidance (21:56)
Medicare Guidance Quiz
Inflation Reduction Act Overview (9:12)
IRA--Part D Payment Stages Updates (10:07)
IRA--Medicare Prescription Drug Payment Plan (M3P) (12:52)
IRA Quiz

CMS Audits

CMS Audits (1:43)
Program Audits (11:49)
RADV & Data Validation Audits (8:42)
PDE & Financial Audits (4:08)
CMS Audits Quiz

Star Ratings

Overview of Star Ratings (3:26)
Calculating Adherence PDC Rates (11:33)
HEDIS, Acumen, Display Measures (3:50)
Quality Improvement Strategies (8:41)
Star Ratings Quiz

Member Communications

Member Communications (2:10)
Explanation of Benefits (EOB) (14:42)
Annual Notice of Change (ANOC) (8:34)
Evidence of Coverage (EOC) (1:05)
Late Enrollment Penalty (LEP) (1:27)
Low-income Subsidy (LIS) rider (0:56)
Coverage Determination Letters (0:36)
Formulary Documents (2:12)
Pharmacy Directory (0:36)
MTM, UM Criteria, Transition Statements (2:11)
Member Communications Quiz

Pharmacy Benefit Manager (PBM) Fundamentals

Overview of PBM (1:43)
Services Provided by PBMs (14:31)
PBM Fundamentals Quiz

Becoming a Medicare Insurance Agent

Medicare Agent Resources
Overview (9:47)
Contracting & Commissions (16:31)
Agent Prerequisite Course Overview (9:33)
Agent Quiz
Agent Marketing Guidelines (8:38)

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Ch.9 Compliance Program

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