CMS Audit Annual Report Highlights Importance of Mock Audits

Beth Matel

Imagine you are the Compliance Officer of your health plan, and you see the email from the Centers for Medicare & Medicaid Services (CMS) announcing you have been selected for a program audit. Did you take the opportunity in the months leading up to this day to confirm your organization can pull compliant universes? Did you take the time to perform some mock reviews with your Organization Determinations, Appeals, and Grievances (ODAG), Coverage Determinations, Appeals, and Grievances (CDAG), Formulary Administration (FA), Special Needs Plan Model of Care (SNP-MOC), if applicable, and Compliance Program Effectiveness (CPE) staff to ensure they are comfortable and skilled presenters? What about your first-tier, downstream, and related entities (FDRs)? Or did you wait, thinking you had plenty of time to get this done?

Read more

Leave a comment | Share | |

2018 Audit & Enforcement Conference: Program Audit Changes on the Horizon

Regan Pennypacker

On Monday, I provided some highlights of last week’s conferences during our weekly Insider call. The Centers for …

Read more

Leave a comment | Share | |

President Trump unveils a Blueprint to Lower Drug Prices

Jean LeMasurier

On May 11, 2018, President Trump unveiled his Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs entitled …

Read more

Leave a comment | Share | |

Are you operating under a false sense of security for your risk adjustment program?

Jessica Smith

Risk adjustment at its highest form is nothing more than a calculation. The unique processes surrounding the operations …

Read more

Leave a comment | Share | |

Supplemental Benefits: New Rules and New Opportunity

Debra Devereaux

Two recent Centers for Medicare & Medicaid Services (CMS) Health Plan Management System (HPMS) memos clarified supplemental benefit …

Read more

Leave a comment | Share | |

Could Medicare Advantage Be Facing More Legislative Reform This Year?

Olga Walther

The House Ways & Means Committee held a hearing Tuesday on the Medicare Advantage (MA) program. Lawmakers eagerly …

Read more

Leave a comment | Share | |

CMS Officials Go On Speaking Tour – Give Hints of Agenda to Come

Olga Walther

Though Congress is on recess, health care policy was very embedded in conversation, with the Department of Health …

Read more

Leave a comment | Share | |