Overview
Nivano Physicians maintains comprehensive compliance training programs in accordance with 42 CFR ยงยง422.503 and 423.504 requirements for Medicare Advantage and Part D plan compliance. Our training programs ensure all staff members understand and comply with CMS regulations and guidelines.
Regulatory Framework
Our compliance training program is designed to meet the requirements of:
- 42 CFR Part 422, Subpart M – Medicare Advantage Compliance Requirements
- 42 CFR Part 423, Subparts M and U – Part D Prescription Drug Plan Compliance
- CMS Compliance Training, Education & Outreach (CTEO) standards
- Medicare Managed Care Manual Chapter 21 guidelines
- Prescription Drug Benefit Manual Chapter 9 requirements
Required Training Components
Part C (Medicare Advantage) Training
Our Part C compliance training covers:
- Organization Determinations – Decision-making processes and timelines
- Appeals and Grievances – Processing procedures and member rights
- Coverage Determinations – Medical necessity and prior authorization
- Marketing and Sales – CMS-approved marketing materials and practices
- Enrollment and Disenrollment – Proper procedures and documentation
- Quality Assurance – Stars ratings and quality improvement programs
- Network Management – Provider credentialing and oversight
- Fraud, Waste, and Abuse – Detection and prevention strategies
Part D (Prescription Drug Plan) Training
Our Part D compliance training includes:
- Coverage Determinations – Formulary management and exceptions
- Appeals and Grievances – Multi-level appeal processes
- Prescription Drug Event (PDE) – Data submission requirements
- Low-Income Subsidy (LIS) – Eligibility and processing
- Medication Therapy Management (MTM) – Program requirements
- Pharmacy Network Management – Contract compliance and oversight
- Part D Reporting – CMS reporting obligations
- Fraud, Waste, and Abuse – Prescription drug-specific issues
Training Delivery Methods
Web-Based Training Platform
Our CMS-compliant online training platform provides:
- Interactive learning modules with multimedia content
- Progress tracking and completion monitoring
- Automated certification upon successful completion
- Downloadable resources and reference materials
- Mobile-friendly access for flexible learning
- Multi-language support where appropriate
In-Person Training Sessions
We conduct regular in-person training for:
- New employee orientation – Comprehensive compliance overview
- Annual refresher training – Updates on regulatory changes
- Specialized role training – Position-specific requirements
- Emergency training – Critical compliance updates
Course Completion Requirements
Mandatory Training Schedule
- New Employees: Complete initial training within 30 days of hire
- Annual Training: All staff must complete refresher training by December 31st
- Targeted Training: Additional training based on role changes or regulatory updates
- Remedial Training: Required for compliance violations or knowledge gaps
Certification and Documentation
Our training program maintains:
- Individual training records for all staff members
- Completion certificates with verification codes
- Competency assessments and testing results
- Continuing education credits where applicable
- Audit trail documentation for CMS reporting
Specialized Training Programs
Compliance Officer Training
Advanced training for compliance officers includes:
- CMS Audit Preparation – Documentation and response procedures
- Regulatory Interpretation – Understanding complex CMS guidance
- Investigation Procedures – Handling compliance violations
- Corrective Action Planning – Implementing effective solutions
- Stakeholder Communication – Reporting to leadership and CMS
Customer Service Training
Training for member-facing staff covers:
- Member Rights and Responsibilities – Understanding Medicare beneficiary protections
- Grievance Handling – Proper documentation and escalation
- Privacy and Security – HIPAA compliance in member interactions
- Cultural Competency – Serving diverse member populations
- Emergency Procedures – Handling urgent member needs
Training Resources and Materials
CMS-Approved Resources
We utilize official CMS training materials including:
- Medicare Learning Network (MLN) publications
- CMS Training Modules and webinars
- Medicare Managed Care Manual updates
- Prescription Drug Benefit Manual revisions
- CMS Memos and Guidance documents
Internal Training Materials
Our custom training materials include:
- Policy and procedure manuals specific to our operations
- Case studies and real-world examples
- Quick reference guides for daily operations
- Compliance checklists and workflow tools
- Video training libraries with subject matter experts
Training Effectiveness Measurement
Assessment Methods
We evaluate training effectiveness through:
- Pre and post-training assessments measuring knowledge gain
- Practical application exercises testing real-world skills
- Compliance monitoring tracking behavior changes
- Member satisfaction surveys reflecting service quality
- Audit results demonstrating regulatory compliance
Continuous Improvement
Our training program continuously improves through:
- Regular curriculum review and updates
- Feedback collection from trainees and supervisors
- Performance data analysis identifying knowledge gaps
- Best practice sharing across departments
- External training evaluation by compliance experts
Reporting and Documentation
CMS Reporting Requirements
We maintain comprehensive documentation for:
- Training completion rates by department and role
- Competency assessment results and remediation plans
- Training effectiveness metrics and improvement initiatives
- Compliance violation trends and training responses
- Annual training program evaluation and strategic planning
Record Retention
Training records are maintained per CMS requirements:
- Individual training records: 10 years from completion
- Course materials and curricula: Current version plus 3 years
- Assessment and certification records: 10 years from issuance
- Training program audits: 10 years from completion
Contact Information
For questions about CMS compliance training:
Compliance Training Department
- Email: compliance@nivanophysicians.com
- Phone: (916) 407-2000
External Training Resources
CMS Training Opportunities
- CMS National Training Program webinars and conferences
- Medicare Plan Payment System training sessions
- Quality Rating System educational programs
- Special Needs Plan specialized training
Professional Development
- American Health Lawyers Association compliance training
- Health Care Compliance Association certification programs
- Medicare Advantage Summit annual conference
- Part D Summit prescription drug compliance training
This training program is regularly updated to reflect current CMS requirements and industry best practices.
Document Version: 1.0
Effective Date: August 7, 2025
Next Review Date: August 7, 2026