FDR (First-Tier, Downstream or Related Entity)
MediGold may enter into contracts with FDRs to provide administrative or health care services to Medicare beneficiaries enrolled with MediGold.
Medicare program requirements apply to FDRs; thus, MediGold must monitor and audit FDRs to ensure the FDR's compliance with all applicable federal and state laws, rules and regulations. Onsite audits may be conducted when deemed appropriate by MediGold, often as the result of a risk assessment, the tracking and trending of member complaints related to access, service or care provided or FDR performance below acceptable service level metrics.
FDRs that conduct their own audits should provide a summary of the audit work plan and results that relate to the services the FDR performs for MediGold.
When FDR non-compliance with CMS regulations occurs, a corrective action plan will be requested by MediGold.
FDR Manual and Code of Conduct