48
Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training 2017 CMS General Compliance Training 1. Medicare Parts C and D General Compliance Training

2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Embed Size (px)

Citation preview

Page 1: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

2017 CMS General Compliance Training

1. Medicare Parts C and D General Compliance Training

Page 2: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.3 Introduction

Page 3: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.4 Introduction

Page 4: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.5 Introduction

Page 5: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.6 Why Do I Need Training?

Page 6: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.7 Training Requirements

Page 7: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.8 Learn More

Page 8: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.9 Course Content

Page 9: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.10 Course Objectives

Page 10: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.11 Introduction and Learning Objectives

Page 11: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.12 Compliance Program Requirement

Page 12: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.13 What is an Effective Compliance Program?

Page 13: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.14 What is an Effective Compliance Program? (continued)

Page 14: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.15 Seven Core Compliance Program Requirements

Page 15: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.16 Seven Core Compliance Program Requirements (continued)

Page 16: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.17 Seven Core Compliance Program Requirements (continued)

Page 17: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.18 Compliance Training - Sponsors and their FDRs

Page 18: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.19 Ethics - Do the Right Thing!

Page 19: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.20 How Do You Know What Is Expected of You?

Page 20: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.21 What is Non-Compliance?

Page 21: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.22 What is Non-Compliance? (continued)

Page 22: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.23 Know the Consequences

Page 23: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.24 Non-Compliance Affects Everybody

Page 24: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.25 How to Report Potential Non-Compliance

Page 25: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.26 How to Report Potential Non-Compliance (continued)

Page 26: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.27 What Happens After Non-Compliance is Detected?

Page 27: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.28 What Are Internal Monitoring and Audits?

Page 28: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.29 Lesson Summary

Page 29: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.30 Compliance Is Everyone's Responsibility

Page 30: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.31 Lesson Review

Page 31: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.32 Knowledge Check

Page 32: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.33 Knowledge Check Answer

Page 33: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.34 Knowledge Check

Page 34: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.35 Knowledge Check Answer

Page 35: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.36 Knowledge Check

Page 36: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.37 Knowledge Check Answer

Page 37: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.38 Knowledge Check

Page 38: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.39 Knowledge Check Answer

Page 39: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.40 You've completed the lesson!

Page 40: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.41 Post-Assessment

Page 41: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.42 Question 1 of 10

Compliance is the responsibility of the Compliance Officer, Compliance

Committee, and Upper Management only.

Correct Choice

True

False

1.43 Question 2 of 10

Ways to report a compliance issue include:

Correct Choice

Telephone hotlines

Report on the Sponsor’s website

In-person reporting to the compliance department/supervisor

All of the above

Page 42: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.44 Question 3 of 10

What is the policy of non-retaliation?

Correct Choice

Allows the Sponsor to discipline employees who violate the Code of Conduct

Prohibits management and supervisor from harassing employees for misconduct

Protects employees who, in good faith, report suspected non-compliance

Prevents fights between employees

1.45 Question 4 of 10

These are examples of issues that can be reported to a Compliance Department:

suspected Fraud, Waste and Abuse (FWA); potential health privacy violation,

and unethical behavior/employee misconduct.

Correct Choice

True

False

Page 43: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.46 Question 5 of 10

Once a corrective action plan begins addressing non-compliance or Fraud, Waste,

and Abuse (FWA) committed by a Sponsor’s employee or First-Tier, Downstream, or

Related Entity’s (FDR’s) employee, ongoing monitoring of the corrective actions is

not necessary.

Correct Choice

True

False

1.47 Question 6 of 10

Medicare Parts C and D plan Sponsors are not required to have a compliance

program.

Correct Choice

True

False

1.48 Question 7 of 10

At a minimum, an effective compliance program includes four core requirements.

Correct Choice

True

False

Page 44: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

Published by Articulate® Storyline www.articulate.com 2017 CMS General Compliance Training

1.49 Question 8 of 10

Standards of Conduct are the same for every Medicare Parts C and D Sponsor.

Correct Choice

True

False

1.50 Question 9 of 10

Correcting non-compliance ______________________.

Correct Choice

Protects enrollees, avoids recurrence of the same non-compliance, and promotes

efficiency

Ensures bonuses for all employees

Both A. and B.

1.51 Question 10 of 10

What are some of the consequences for non-compliance, fraudulent, or unethical

behavior?

Correct Choice

Disciplinary action

Termination of employment

Exclusion from participation in all Federal health care programs

All of the above

Page 45: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

2017 CMS General Compliance Training Answer Key

1.42 Question 1 of 10

Compliance is the responsibility of the Compliance Officer, Compliance

Committee, and Upper Management only.

Correct Choice

True

X False

1.43 Question 2 of 10

Ways to report a compliance issue include:

Correct Choice

Telephone hotlines

Report on the Sponsor’s website

In-person reporting to the compliance department/supervisor

X All of the above

Page 46: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

1.44 Question 3 of 10

What is the policy of non-retaliation?

Correct Choice

Allows the Sponsor to discipline employees who violate the Code of Conduct

Prohibits management and supervisor from harassing employees for misconduct

X Protects employees who, in good faith, report suspected non-compliance

Prevents fights between employees

1.45 Question 4 of 10

These are examples of issues that can be reported to a Compliance Department:

suspected Fraud, Waste and Abuse (FWA); potential health privacy violation,

and unethical behavior/employee misconduct.

Correct Choice

X True

False

Page 47: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

1.46 Question 5 of 10

Once a corrective action plan begins addressing non-compliance or

Fraud, Waste, and Abuse (FWA) committed by a Sponsor’s employee or

First-Tier, Downstream, or Related Entity’s (FDR’s) employee, ongoing

monitoring of the corrective actions is not necessary.

Correct Choice

True

X False

1.47 Question 6 of 10

Medicare Parts C and D plan Sponsors are not required to have a

compliance program.

Correct Choice

True

X False

1.48 Question 7 of 10

At a minimum, an effective compliance program includes four core requirements.

Correct Choice

True

X False

Page 48: 2017 CMS General Compliance Training 1. Medicare … · Published by Articulate® Storyline 2017 CMS General Compliance Training 2017 CMS ... 2017 CMS General Compliance Training

1.49 Question 8 of 10

Standards of Conduct are the same for every Medicare Parts C and D Sponsor.

Correct Choice

True

X False

1.50 Question 9 of 10

Correcting non-compliance ______________________.

Correct Choice

X Protects enrollees, avoids recurrence of the same non-compliance, and promotes

efficiency

Ensures bonuses for all employees

Both A. and B.

1.51 Question 10 of 10

What are some of the consequences for non-compliance, fraudulent, or unethical

behavior?

Correct Choice

Disciplinary action

Termination of employment

Exclusion from participation in all Federal health care programs

X All of the above