New compliance language added to Medicare Advantage provider agreement

Please read the new compliance language in your Medicare Advantage PPO Provider Agreement. The language, required by the Centers for Medicare & Medicaid Services, takes effect July 1, 2013. BCBSM alerted you March 26 through web-DENIS about this change.

The new language in your agreement stems from a new Chapter 21 in the Medicare Managed Care Manual titled “Compliance Program Guidelines.” Issued by CMS in 2012, it lists requirements for Medicare compliance. See cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf*.

Blue Cross Blue Shield of Michigan must comply with the new guidelines. Your provider agreement requires you and your vendors to also comply with all CMS rules, regulations and guidelines. The new CMS guidelines aim to reduce Medicare fraud, waste and abuse through key compliance requirements.

Complying with the new guidelines also aligns you with future requirements of Section 6401 of the Patient Protection and Affordable Care Act. It requires Medicare, Medicaid and the Children’s Health Insurance Program (MIChild in Michigan) to create compliance programs as a condition of enrollment.

Questions? Contact your provider consultant.

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