PBM Compliance
Protect your business and your brand.
Although it’s your client’s name on the hook with CMS, your ability to demonstrate compliant processes and outcomes through every stage of the adjudication of Part D claims is no less critical. Further, an ability to attest to the highest standards of fealty with Federal regulations is a critical differentiator in a market that is full with "good enough" approaches to client services. GHG can provide a consulting team with Medicare Advantage auditing expertise to complete the following functions:
- Review current Medicare processes, policies and procedures and determine compliance with CMS regulations and guidance.
- Assist your PBM with creating a CMS Audit road map to demonstrate compliance with Medicare regulations and guidelines.
- Conduct mock interviews with key personnel as part of the evaluation process
- Assist in the review of CMS selected samples prior to the CMS site review and provide preliminary audit findings.
- If a desk review is conducted assist in the preparation of the sample case files being forwarded to the regulators.
- Be present at your site during any CMS site review to provide consultation and advice.
For more information, please contact us at 202-364-8283.
