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ComplianceWith the Centers for Medicare and Medicaid Services (CMS) scrutinizing Medicare plans more closely than ever, compliance is again a front and center plan priority. The costs of non-compliance with CMS are significant. In recent months, CMS has radically changed its audit practices. Leveraging the Parts C and D data it has been collecting from your plan, CMS is identifying outliers and swiftly moving in with large audit teams, disrupting operations and beginning a lengthy period of corrective action. Plans must now be on an audit footing at all times. This means closing the gap between your compliance officer and the rest of the organization. Compliance may be a department, but it is not a job function, like enrollment or medical management. It is an attitude that permiates every department, and is supported by proper tools and rigorous oversight. Executives are wise to remember that most compliance issues begin life as operational issues. Compliance can therefore be seen as a warning system for operational inefficicies or threats to member satisfaction. Learn more about how we can help you here. Mock CMS Audits and Focused AuditsThis highly structured service analyzes your health plan’s and/or prescription drug plan’s operations and replicates the actual CMS audit processes. CMS Audit Preparation ServiceFor Medicare Advantage Plans (MA) and Medicare Prescription Drug Plans (PDPs) Fraud, Waste, and Abuse (FWA) AuditsHaving an effective Medicare FWA prevention, detection, and reporting program in place is required by CMS -- and protects plans financially from potential fraud. Appeals, Grievances, and DeterminationsMany Medicare plans have been found by CMS to have deficiencies in the Appeals, Grievances, and Determinations area. Sales Training and CertificationPlan-Specific Solutions for Training, Testing, and Certifying Your Brokers. Document Actions |
