All About FDR: First-Tier, Downstream and Related Entities

General August 14, 2017 0
All About FDR | Senior Market Advisors

In the Medicare industry, FDR takes on a different meaning that is not our 32nd president. It stands for First-Tier, Downstream, and Related Entities. You, as an agent, may be considered an FDR. What does it mean?

First-Tier Entities

A First-Tier Entity is anyone who has a written agreement approved by CMS and provides administrative or health care services to Medicare-eligible individuals with MA (Medicare Advantage) or Part D (prescription drug coverage).

Downstream Entities

A Downstream Entity is anyone who has a written agreement approved by CMS with individuals involved with MA or Part D that is below the level of a First-Tier Entity.

Related Entities

A Related Entity is anyone who is related to an MA or Part D organization/sponsor and performs some management functions, provides service with a written agreement, or leases property or sells materials with a cost of more than $2,500 during a contract period.

If you’re contracted with a carrier as an agent licensed to sell MA or Part D, you are most likely an FDR. What does this mean for you?
The title “FDR” brings special compliance guidelines with it. You may hear the term tossed around in the context of “FDRs need to complete this training” or “FDRs are required to…”

As an FDR, you are required to complete all of your training by 90 days after your hire date and renewed annually. If you do not complete your training, CMS has the right to terminate your contract and stop you from selling. Training includes:

  • CMS FWA (Fraud, Waste, and Abuse) training
  • General CMS compliance training
  • Code of conduct policy distribution
  • Exclusion list screenings (checks your history of working in health care)
  • Any other federal and state certifications

It’s in your best interest to hold on to any verifications and evidence of your certifications and trainings.

You can find our guide on training centers here, and our guide on Medicare Fraud, Waste, and Abuse here for more information.

Anastasia Iliou
Anastasia Iliou
Content Marketing Manager at Senior Market Advisors
Anastasia graduated from Belmont University with a Bachelor's degree in Songwriting. When she's not writing, she's on a mission to visit all 50 states in the U.S (and to date has reached 27). Anastasia loves writing music, hiking, and her pet hedgehog, Luna. She loves animals (but not so much bugs) and spends her free time volunteering for The Elephant Sanctuary in Tennesee.