Training & Compliance

  • Compliance Training & Attestation

    • UC San Diego Health Accountable Care Network is committed to regulatory compliance and the highest standards of business integrity. Our goal is to ensure that all ACO participant providers are trained, accountable, and in full compliance with legal, regulatory and ethical standards. We provide compliance training and have all ACO participants attest to their compliance annually.
    • Participant providers of UC San Diego Health Accountable Care Network, an MSSP ACO, are required by CMS regulations to attest to completing appropriate education and training related to the Network’s compliance program requirements and how to identify, correct and prevent potential fraud, waste and abuse. This attestation of compliance is made annually for all participant providers. The basis for this requirement comes from 42 CFR parts 422 and 423 of the Medicare Program.

      • By signing below, I attest that my organization, an MSSP ACO participant in UC San Diego Health Accountable Care Network, Inc. (Network), and all providers billing CMS under my organization’s tax identification number (TIN) for services rendered to Network assigned beneficiaries have read and agree to comply with:

        • (i) All Network policies and procedures and standards;
        • (ii) Prevention of fraud, waste and abuse training requirements in accordance with guidelines set by CMS;
        • (iii) General compliance training requirements in accordance with guidelines set by CMS on an annual basis.
      • My organization shall:

        • (iv) Conduct regular validation checks to ensure compliance with the State and Federal exclusion lists;
        • (v) Retain attestations, individual training records and training materials for 10 years from the last day of the calendar year for the reporting period.
      • I am authorized to bind the entity and I attest that the above information is true and correct. I will notify Network representatives of any changes to this information.
    • UC San Diego Health Accountable Care Network Compliance Training

  • Compliance Issue Reporting

    • Ensuring that the UC San Diego Accountable Care Network is operating at the highest levels of business integrity and in full compliance with local, state and federal regulations, this form provides an anonymous method to report concerns about regulatory compliance, ethical conduct, and fraud or waste to the ACO’s compliance team.

      • For participants who choose to waive anonymity and identify themselves, please include your contact information and our staff will respond within 3-5 business days.

  • Communicating changes to your practice

    • Certain changes to your practice need to be communicated to the ACO per CMS requirements. The ACO will do this for you. Please contact your UC San Diego Health ACO representative, or email, within 3 days of any of the following events:

      • Change to your legal business name (LBN) in PECOS
      • Practice merger or acquisition of a TIN
      • Change in your practice location or a new location
      • New provider in your practice
      • Departure of a provider from your practice
      • Malpractice claims, suspensions of licenses (CA, DEA, hospital privileges, etc.), or other sanctions brought against your practice or providers
    • The fine print regarding malpractice claims and suspensions of licenses:

      • 1.1 Notice of Specified Events. Provider shall advise Network, and Provider shall require each Participating Provider to advise Provider, as promptly as reasonably feasible (but in no event later than three (3) business days) of the following events as to a Participating Provider:

        • (a) filing of a malpractice case against Provider or any Participating Provider, as applicable, and each settlement or judgment of a malpractice claim entered into by Provider or Participating Provider, as applicable;
        • (b) the revocation, suspension or restriction of the Drug Enforcement Administration (“DEA”) number;
        • (c) a voluntary or involuntary diminishment, suspension, termination or relinquishing of licenses;
        • (d) any voluntary or involuntary diminishment, suspension, termination or relinquishing of hospital privileges;
        • (e) the initiation of any potential sanction proceeding by a state licensing authority, state health care program, federal health care program, or governmental body or certification board or body;
        • (f) the initiation of a criminal proceeding of felony or crime involving moral turpitude;
        • (g) any proceeding that could potentially lead to a Participating Provider being precluded from participating in Medicare; or
        • (h) any report concerning such Participating Provider made to the National Provider Data Bank.
    • In addition, it is important to let us know if there are any changes in your designated ACO contacts, namely your:

      • Care management contact
      • Network manager
      • Quality lead contact

Additional Resources

MSSP ACO Population Health Reference Guide

A reference guide for ACO providers using Epic as their EMR. The purpose of this Reference Guide is to provide ACO providers and staff with the Epic workflows for accessing your list of attributed beneficiaries, risk scoring and stratification, viewing a beneficiaries’ Population Healthcare Team (PHT) empanelment status, and referring beneficiaries to the PHT.

MSSP ACO Quality Measure Quick Start Guide

Brief instructions for documenting quality measure information for ACO Providers using Epic as their EMR. The purpose of this Quality Measure Quick Start Guide is to provide ACO participating providers and staff with the steps on how to document patient information in Epic to meet the Quality Measure requirements.

MSSP ACO Quality Reference Guide

Detailed instructions applicable to all ACO providers on all EMRs. The purpose of this Quality Reference Guide is to provide ACO participating providers and staff with the necessary content and recommendations to become familiar with the MSSP Quality Measures and to close Quality Measure Care Gaps. This Quick Reference Guide covers the requirements of the MSSP quality measures, provides clinical recommendations, and electronic health record (EHR) agnostic steps to satisfy each measure, as well as the required documentation needed within the patient chart.