Getting Clarification from CMS

By Jen Sousa, Vice President

Between the Code of Federal Regulations (CFR), Part C and Part D guidance manuals, and HPMS memos, there are literally thousands of pages of material to memorialize CMS’ requirements and expectations. Yet we have all been in a situation where we have a specific scenario or question that is either not addressed in these materials or the requirement or guidance is not clear. Sometimes, you may already know the answer (or at least think you do), but would like to see the response from CMS in writing to validate your interpretation or set you on the correct path. Other times, you may have no idea what the correct answer is and want to get a response directly from CMS. We recommend that these questions be posed in writing so that you have CMS’s response documented for future reference. It’s not uncommon to have to whip out one of these responses during an audit if there’s a question of interpretation of a requirement!

One of the benefits of working with Medicare Compliance Solutions (MCS) is that we can assist you in obtaining answers to these questions. We’ve posed numerous questions to CMS on behalf of clients or ourselves, so it’s possible that we already have the answer from CMS’s mouth. If you have a question that we have not posed to CMS in the past and you want a written response from CMS, we can pose the question to CMS on your behalf. In this case, we do not identify the name of the client that we are representing so that you remain anonymous and get your answer without raising any red flags to CMS.

If you are not an existing client and would like our assistance with a question, please visit our website at https://medicarecompliancesolutions.com/ask-us-anything/. We provide up to 3 free responses to questions and can pose the question directly to CMS if needed. We would love to get to know you and help you get your answer! If you are an existing client, reach out to your MCS Project Manager for help.

Last month, we posed 2 questions to CMS on behalf of our clients and want to share the questions and answers. In both scenarios, the answer was not spelled out in guidance or the client had a reason for wanting the response in writing, so we asked the question on the client’s behalf. We hope you find this helpful.

CPE First Tier Entity Auditing and Monitoring (FTEAM) Universe

Q: Should oversight activities of Field Marketing Organizations (FMOs),r brokers, or agents who have a written agreement directly with the Sponsor be included in this universe? 

Answer from CMS: Yes, these activities should be included in the FTEAM universe.

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