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Compliance

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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CMS launches largest-ever multi-payer initiative to improve primary care

The Centers for Medicare & Medicaid Services (CMS) announced its largest-ever multi-payer initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care […]

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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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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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Audit Protocol

2015/2016 CMS Program Audit Protocols and Process Updates

CMS conducts program audits to evaluate the performance of the Medicare Advantage/Prescription drug plans (MAPDs) and prescription drug plans (PDPs) that provide health care coverage to Medicare eligible beneficiaries. In February of 2015 CMS published […]

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2015-CMS-Audit-Protocol

2015 CMS Audit Protocol: Your Takeaway

In early February, the CMS released its new audit protocols and process updates for 2015 for Medicare Advantage organizations and Part D sponsors. The new audit memorandum has given way to a lot of […]

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seminar

Are you in control of your compliance processes?

May 19, 2015 Compliance maintenance and oversight for health plans can be a resource and time-consuming restraint. Challenges with manual processes, inefficient workflows and frequent compliance audits prove to be disruptive and expensive. Regulatory […]

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