Key FAQs: Medicare Compliance Training

If your practice or facility cares for Medicare-eligible patients, read this important notice and share it with your colleagues.

Q What kind of training is required annually by Highmark?
A Highmark requires Medicare First-tier, Downstream and Related (FDR) entities to complete annual compliance training.
Q Who must complete these trainings?

Every individual who is associated with your practice or facility and works with Highmark’s Medicare Advantage and/or Medicare Part D Prescription Drug Plan (PDP) members and who fall into one of these categories:

  • Employee
  • Governing-body member
  • Temporary worker
  • Contractor
  • Subcontractor
  • Volunteer
Q Why does Highmark require these trainings to be completed by employees, vendors, and others?
A Highmark requires compliance training to ensure that all practices and facilities receiving Medicare dollars understand how to comply with the laws, regulations, guidelines, and policies for the Medicare program and how to prevent, detect, and correct Medicare fraud, waste, and abuse (FWA).
Q When does Highmark require these individuals to complete these trainings?

Compliance training must be completed:

  • At the beginning of the individual’s employment, contract, or appointment: Within 90 days
  • During employment, contract, or appointment: Between Jan. 1 and Dec. 31 every year
Q Where can individuals go to access these trainings?

Individuals have several options for completing these training requirements. They can:

  • Complete compliance trainings online via the CMS Medicare Learning Network
  • Complete the compliance and FWA training offered by your practice or facility
Q What proof must be provided that the trainings were completed?

Individuals must review the training programs in their entirety and present one of the following acceptable forms of evidence:

  • Sign-in sheets
  • Individual employee attestations
  • Electronic certifications

The records must include:

  • Time
  • Attendance
  • Topic
  • Certificates of completion (if applicable)
  • Test scores (if applicable)

Proof of training completion must be provided to Highmark upon request. Training records must be maintained for the period of the provider's contract with Highmark, plus an additional 10 years.

Q Are there any exceptions to these guidelines?
A Yes. FDRs who have met the FWA training and education certification requirements through enrollment into Parts A or B of the Medicare program or through accreditation as a supplier of durable medical equipment, prosthetics, orthotics, and supplies are deemed to have met Highmark’s annual compliance training requirements.