Why A&G timeliness failures repeat, and why CMS considers them systemic
Appeals and Grievances timeliness failures rarely happen because teams do not understand the rules. Most payer organizations know the timelines,
CMS program audits
Delegation Oversight Risk: Why Health Plans Are More Exposed Than They Think
Delegation oversight risk is increasing as delegated entity risk and downstream entity compliance risk expand across payer operations. Delegation oversight
Why CMS audits are designed to test operations, not just documentation
For years, health plans treated CMS audits as documentation exercises. If policies looked current, files appeared complete, and evidence arrived
CMS Program and Focus Audits: Are You Prepared?
Starting January 2024, the Medicare Parts C and D Oversight and Enforcement Group of the Centers for Medicare & Medicaid