If your practice is contracted with any Medicare Advantage health plans, you are subject to meeting certain requirements with regard to providing offshore services. Let’s break down what this means for the integrity and security of your practice.
FDRs
An FDR is a U.S. Centers for Medicare & Medicaid Services (CMS) acronym that means first tier, downstream or related entity.
Current CMS definitions
A first-tier entity is any party that enters a written arrangement, acceptable to CMS, with a Medicare Advantage (MA) organization or Part D plan sponsor or applicant. These arrangements provide administrative or health care services to a Medicare-eligible individual under the MA program or Part D program.
A downstream entity is any party that enters a written arrangement, acceptable to CMS, with persons or entities. These persons or entities are involved with the MA benefit or Part D benefit. These arrangements continue down to the level of the ultimate provider of both health and administrative services.
Health care providers are FDRs, too. The compliance requirements apply to health care providers contracted within a MA’s network. This includes physicians, hospitals, and other provider types, like dentists.
Health care providers within a MA’s network, such as physicians, hospitals, and dentists, must comply with Medicare requirements. Here are the key reasons:
- FDRs must meet Medicare Compliance Program requirements when providing services for Medicare plans.
- Third parties can perform health care functions under an MA organization’s contract, making them subject to CMS compliance.
- FDRs offer administrative services like claims processing, patient management, and credentialing, and can include entities such as delegates, pharmacies, and others.
Medicare Compliance Program Requirements
Here are some of the actions you must take:
• Distribute a code of conduct or a compliance policy
• Distribute conflict of interest policy
• Distribute general compliance and FWA education and training
• Complete exclusion list screenings
• Make employees aware of reporting mechanisms
• Report FWA and compliance concerns
• Report and request to use offshore operations
• Fulfill specific federal and state compliance obligations
• Monitor and audit FDRs
FDR Attestation
If you receive an attestation, it must be signed by someone in your organization who has responsibility, directly or indirectly, for all:
• Employees
• Contracted personnel
• Providers and practitioners
• Vendors that provide health care and/or administrative services for Medicare plans.
The signee could be your compliance officer, chief medical officer, practice manager or administrator, an executive officer, or someone else in a similar position.
