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Author: Vipul Sanghvi

CMS Audit Universes as a Tool for Ongoing Compliance Monitoring

One of the most arduous and time-consuming activity for MAPD and PDP plans is the creation of the required universes for submission to the CMS. Health plans often struggle with the critical step of […]

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ada

Americans with Disabilities Act (ADA) Changes

I attended a call recently with CMS and the ADA, CMS is looking to adhere to the Americans with Disabilities Act (ADA), when it comes to assessing monetary penalties to health plans that are […]

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cost-per-complaint

Optimize your Appeals and Grievances Process

When it comes to appeals and grievances, most healthcare organizations struggle to improve compliance, productivity, visibility, and ratings while lowering penalties. Steps to optimize your Appeals and Grievances process: Make reaching out to complain a child’s […]

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Outreach

Reasonable Outreach: Are you missing what CMS expects?

The Centers for Medicare & Medicaid Services (CMS) on April 20th of 2016 released several job aids in order to assist plan sponsors with improving their operations and ensuring compliance with CMS requirements. These […]

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