Are you in control of your compliance processes?

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 demands for health plans can result in higher costs, … Read More

2015 CMS Audit Protocol: Your Takeaway

In early February, the CMS released its new audit protocol and process updates for 2015 for Medicare Advantage organizations and Part D sponsors. The new audit protocol memorandum has given way to a lot of speculation and confusion among the … Read More

2015/2016 CMS Program Audit Protocols and Process Updates

CMS program audit 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 the audit protocols that will be utilized … Read More

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 job aides are based on common … Read More

How To Optimize your Appeals and Grievances Process?

When it comes to appeals and grievances process, 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 play: Complaints are … Read More

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 not providing information in an alternative … Read More