Your Compliance Plan and FDR

Your Compliance Plan and FDR

No, not Franklin Delano Roosevelt! FDR is a CMS acronym for First tier, Downstream, or Related entity. A First Tier Entity is any party that enters into a written arrangement (acceptable to CMS) with a Medicare Advantage (MA) organization to provide administrative or health care services to a Medicare-eligible individual in the MA program. Most chiropractic providers fall into this category.

CMS requires all providers and/or health care professionals contracted with a Medicare product—including Medicare Advantage plans—to attest to their understanding of and adherence with compliance program requirements when they sign the initial contract and annually thereafter.

What Should You Do?

• If you are a contracted provider with a Medicare Advantage Plan, research the Provider Portal for ‘FDR Requirements.’ Some list it as Fraud, Waste and Abuse, and General Compliance Training. Note: Fraud, Waste, and Abuse (FWA) training is not the only aspect of this requirement; there are several steps that must be taken in order to meet the Medicare Compliance FDR standards.
• If you received notification or a letter asking your clinic to attest, be sure to follow all of the directions in the notification. Attesting requires you to provide supporting evidence of compliance. That means you must have written proof of FWA training, proof that you checked the OIG exclusion list for all team members, and Code of Conduct policy with proof of training, among other specific requirements. Note: All of these items must be recorded in your Compliance Manual.

What Should You Know?

• Since January 2016, CMS has required practices to consult the CMS compliance training materials available in the CMS Medicare Learning Network here.
• Download a copy of your contracted payer’s FDR Compliance instructions and check off each step once it is completed. We have provided links to some of the major payers at the bottom of this Fact Sheet but please note that payers update this information on a regular basis so links may not work. We encourage you to search the payer portal for current links.
• Maintain all records of completion (method used, copy of training materials, dated employee training logs, attestations, and/or electronic certifications that include the date of the training) for 10 years.

KMC University’s Compliance Program

If you have put together your compliance program with KMC University’s or other materials, you may be all set. The sentencing guidelines for the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, required that enrolled Medicare providers have a viable compliance program as of 2010. Our program and materials guide you through what you must do in order to create that internal program.