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...
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...
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...
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....
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...
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...
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...
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,...