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Whether your practice/dental service organization participates with Medicaid or not you could be required to fulfill the following annual training requirements. Read on!
Many insurance networks, including, but not limited to, Medicaid Managed Care Organizations (DentaQuest, MCNA, United Concordia, and others) or Medicare Advantage plans require providers to complete compliance training outlined by the OIG (Fraud, Waste and Abuse Prevention).
The Deficit Reduction Act of 2005 and the Affordable Care Act requires dentists and Dental Service Organizations (or whatever they call themselves today) to establish and maintain corporate compliance programs. Said compliance programs mandate annual compliance training requirements by affected organizations, their employees and contractors. This includes not only the insurance carrier’s employees, but you and your contractors and employees as downstream contractors and organizations.
Fraud, Waste and Abuse (FWA) training must be completed within 90 days of contracting to a carrier that is a covered entity (required to comply) & annually thereafter.
I'm not to present a problem without also presenting a solution. We offer on-demand FWA training. Here is the link:
Let’s clarify who must complete the training:
· Owners (including silent partners);
· C-level executives and board members;
· Contractors (including associate dentists, anesthesiologists, CRNAs who work on Medicaid patients);
· Employees (including associate dentists, office management, dental therapists, hygienists, dental assistants, sterilization technicians, receptionists, treatment coordinators, and all other staff members).
Many insurance networks are jumping on board with these training requirements as they flesh out their corporate compliance programs. I anticipate that in the next few years every insurance network will require compliance training annually by in-network providers.
Again, you may not be a network provider for Medicare or Medicaid, but if you contract to an organization that services Medicare or Medicaid you can be compelled as a contractor (usually outlined in the provider enrollment agreement when dentists and physicians contract to a network).
Be sure to read the fine print of your provider agreements because by signing the dotted you agree to comply with the requirements of the contract including the fees, billing limitations and training requirements.
If you fail to complete training, the insurer can kick you out of their network.
Fraud, Waste and Abuse (FWA) training... Slowtember (September) is coming. Use the opportunity to suck it up and get it done!
We'll talk again soon. Be well!
Dental Compliance Specialists helps make dental offices safer for patients, dentists and their employees. We help our clients develop and maintain their compliance programs including OSHA/Infection Control, HIPAA, DEA regulations and prescribing practices, Radiation Safety, OIG/Medicaid Compliance, Record Auditing, and more by providing actionable systems, easy-to-use tools, robust training, and accountability. Most of our clients have never been in trouble and want to keep it that way. Sometimes, though, dentists call when they are in trouble. In either case, we are there to make a meaningful difference. If you need help call us at 817-755-0035.
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