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A federal regulation that took effect Jan. 1 requires all Medicare Advantage Organizations and Prescription Drug Plan sponsors to provide fraud, waste and abuse training by the end of the year to all entities they are partnering with to provide benefits or services in Part C and Part D programs.

While the regulation states only that the MAOs and PDP sponsors must provide the training, at least one payer in Colorado is requiring certain providers and staff to complete an online training program or to sign an attestation stating they have completed such training by Dec. 31, 2009.

We recommend you check with your payers to make sure you are meeting any requirements they may have and that you add any necessary training to you practice's compliance plan.

Health Plan Training Programs:

Anthem

Rocky Mountain Health Plans

UnitedHealthcare

Regulatory:

Office of the Inspector General, Compliance Program for Individual and Small Group
Physician Practices

Additional Information:

Compliance: The Foundation of a Successful Practice
(Webinar presentation by Marcia Brauchler, Physicians' Ally, Inc. - August 20, 2009)

Compliance Planning on a Shoestring Budget, Physicians News Digest, November 2007

Come Meet the Medicare Recovery Audit Contractor
The Centers for Medicare & Medicaid Services (CMS) is presenting two (2) Medicare Recovery Audit
Contractor (RAC) educational sessions on May 18, 2009 and May 20, 2009 for the Colorado Medical
Society Members and their Staff. The purpose of these sessions is to provide information on the RAC
program and to introduce providers to Connolly Consulting, the RAC for the State of CO.

Click here for the handouts

Implementing C.R.S. 25-37-101 (SB 79) In Your Practice - It is important to be able to compare your “new” contracts to your existing contracts. Some payers may only be sending amendments to address issues of compliance with the Law. Others may be sending complete contracts that include the current requirements.

The purpose of the Law is to provide transparency around key contract provisions so physicians will have a clear idea of what they will be paid, how they will be paid and know that the payer cannot make changes unilaterally once the contract is signed. It is the obligation of the payers to bring contracts into compliance with the provisions of the Law; and it is the obligation of each practice to review the contracts for payer compliance with the Law. All payers doing business in Colorado must bring their contracts into compliance no later than December 31, 2008.

The Health Care Financing Division staff has put together some educational materials for physicians and their staff to use when evaluating these communications. These materials can be found on the Practice Management Community in the Contracting Neighborhood Resources.

CMS will be tracking health plan/payer/PPO, etc. compliance with all the provision of the statute. As issues are identified we will be working with the Colorado Association of Health Plans and/or the individual health plan/payer/PPO, etc.

Physicians and their staff are key to monitoring compliance! It is important for you to keep CMS informed:

If you have questions, contact the CMS Health Care Financing Division:
Marilyn Rissmiller, (720) 858-6328, fax (720) 859-7509 or marilyn_rissmiller@cms.org
Sara Burnett, (720) 858-6313, fax (720) 859-7509 sara_burnett@cms.org

Practice Tracking Survey Are you or someone you know closing or opening a medical practice? Please take a minute to complete this short survey!

Educational Programs Brown Bag Teleconference, Quarterly Meetings, and more

CMS LiveWire Electronic Newsletter

Claims Resolution Assistance for issues relating to claims processing

Health Plan Complaints for general issues relating to a health plan

Special Alerts!

Fraud Waste & Abuse Resources

Colorado Division of Insurance

Colorado Division of Workers' Compensation

Medicaid

Medicare
_- Centers for Medicare and Medicaid Services
_- TrailBlazers Health Enterprises, LLC
______- Colorado J4 MAC Implementation