• Medicare Compliance Requirements Are Changing – Are You Up to Date?


    Medicare Advantage plans are starting to change their compliance-training requirements for participating providers. If you participate in a Medicare Advantage or prescription drug plan, you should check their requirements to ensure you’re in compliance.

    Why you need to check requirements

    The Centers for Medicare and Medicaid Services require all Medicare Advantage organizers and prescription drug plan sponsors to perform annual compliance training, including on fraud, waste and abuse. To comply with the mandate, these plans require all participating providers to complete training.

    • CMS has required the training for some time, but recently required it of more entities than before.
    • To streamline the process, CMS provided web-based training that Medicare Advantage plans could offer to their providers.
    • Due to differences in standards, however, the new CMS training meant some providers had to complete more training – both the CMS version and their Medicare Advantage plan’s.
    • Because of the added burden, CMS suspended an attestation requirement until all Medicare Advantage plans had adopted standardized training.
    • Some plans and sponsors have already adopted the CMS training programs so that providers can meet all Medicare Part B, Cand D requirements with one training session per year. 

    Who must complete the training

    • Both Medicare Parts C and D may have their own training guidelines. They may require you to initiate and attest to completion of training as a condition of your contract.
    • All new hires should have training within their first 90 days.
    • Not all staff must have training, but those claims processors and those in management or decision-making roles should be well-versed in conditions of practice compliance. 

    You can fulfill both the CMS training requirements by either completing the agency’s web-based training or incorporating its standardized training modules into existing compliance training, systems,or documents.

    For more information on compliance training certification, review the CMS Compliance Program Policy and Guidance and Compliance Program Training Requirements and Audit Process update.