I know, I know – it’s only Spring and you have plenty of time.

Truth be told this year will FLY by.

Hanukah, Christmas, Kwanza, and New Year’s will be here before you know it.

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) service Medicare Advantage or Dual Eligible individuals.

The Deficit Reduction Act of 2005 and the Affordable Care Act requires those organization 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.

Many insurance networks will only recognize compliance training completed via the Centers for Medicaid and Medicare Services (CMS) Medicare Learning Network (MLN).

There are two required courses that must be completed within 90 days of contracting to a carrier that is a covered entity (required to comply) & annually thereafter:

1.     Combatting Medicare Parts C and D Fraud, Waste & Abuse (30 minutes)

2.     Medicare Parts C and D General Compliance (20 minutes)

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).

There is no cost for training on the MLN. You and your staff just have to log in and do it.

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. 

Even in the face of government deregulation, this trend shows no sign of going away any time soon, so figure out how to make it happen.

To access the training each participant will need to create an account. Here is the website URL:  

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