Medicare Advantage & Part D Compliance Training - Recognizing and Reporting Fraud Waste and Abuse

Medicare Contractors - Meet First Tier & Downstream Entity FWA Compliance Training Needs with NHCAA.

The Centers for Medicare & Medicaid Services (CMS) requires that all employees who work for or contract with Medicare Part C Medicare Advantage Programs (MA) or Part D Medicare Prescription Drug Programs (PDP) meet annual compliance and education training requirements with respect to Fraud Waste & Abuse (FWA).

NHCAA with the input of the Blue Cross Blue Shield Association has developed a computer-based training program titled Medicare Advantage and Part D Compliance Training -Recognizing and Reporting Fraud Waste and Abuse. It is intended to be offered to first tier, downstream and related entities including physicians, vendors, subcontractors and hospitals. The program will provide an understanding of general FWA, increase awareness of FWA occurrences, FWA compliance oversight procedures and resources.

This program is now available online. To arrange a demonstration or for more information please contact Erin Carlson at ecarlson@nhcaa.org.

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Preventing Fraud, Waste & Abuse - General Training

As part of the Medicare Part D - Prescription Drug Benefit, CMS released final guidance in April 2006 for compliance guidance to all Medicare Part D Sponsors titled "CMS Prescription Drug Benefit Manual, Chapter 9 - Part D Program to Control Fraud, Waste and Abuse". Section 50.2.3 of the Manual dictates that all Sponsors and their "downstream entities", which include pharmacists and pharmacy workforce members engaged in delivering any Medicare services, receive general and specialized training to prevent fraud, waste and abuse.

This Level One course is designed to introduce health care fraud investigators to the basic coding nomenclature, and provide the information needed to analyze medical record documentation to uncover and investigate questionable claims.

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