Three Levels of FDR Entities and the Compliance Responsibilities of Medicare Advantage

FDR Entities and Medicare Advantage
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FDR Entities and Medicare Advantage
The three levels of FDR entities are the First Tier, Downstream, and the Related Entity (FDR). In particular, the Centers for Medicare and Medicaid Services (CMS) is the one responsible for monitoring the FDRs. The paper focuses on the three FDR levels, provides examples of each, and explains the compliance responsibilities that a Medicare Advantage (MA) sponsor holds for its FDRs.
A first-tier entity entails a party that enters into a particular written arrangement that is acceptable by the CMS with a Part D plan sponsor or a MA. In particular, it offers healthcare or administrative services to people eligible for Medicare under part D or MA programs (Health Partners Plans, n.d.). The best examples of first-tier entities are fulfillment vendors, call centers, field marketing organizations, and independent practice associations. The CMS is required to oversee the functions of first-tier entities as they provide administrative healthcare services to their Medicare beneficiaries.
When it comes to the downstream entities, they are parties that are acceptable to the CMS that enter written arrangements with people involved with part D or MA benefit. They are below the arrangement level between the MA organization, part D plan sponsor, or applicant of the first tier entity (Health Partners Plans, n.d.). At this juncture, the level of the written arrangement proceeds to go down to the final provider or administrative and healthcare services. A good example of a downstream entity is a hospital that is within the healthcare system and has entered into the system of level agreement. Moreover, a credentialing verification firm can be considered a downstream entity.
Furthermore, related entities have part D or MA organization control or common ownership. They perform part D or MA o...