CMS requires us to oversee our first tier, downstream, and related entities (FDRs) and downstream and delegated entities (DDEs) that assist us in providing services for our Medicare and qualified health plan (QHP) beneficiaries.

As an FDR in Medicare Advantage and Part D plans or DDE in the QHP programs, you are an important partner in the continued success of our government programs. Payment received for services, are in whole or in part, from federal funds. As such, CMS requires FDRs/DDEs to participate in our government compliance program.

Learn about required compliance training and use our tools to ensure you meet obligations under our government compliance program.

We recommend that providers and their staff become familiar with resources to learn more about coding and risk adjustment. Some resources that may be beneficial for you include:

• ICD-10-CM coding guidelines
• American Hospital Association (AHA) Coding Clinic
• American Health Information Management Association (AHIMA) Education
• American Academy of Professional Coders (AAPC)
• Resource Initiative & Society for Education (RISE)