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- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
- William on Will Trump and Price Pull Out the Scalpels for Star Ratings?
- Bobby on January Release of the Draft MMG – Perfect Timing
- Pam Lassila on Best Practices and Common Conditions of Audit Preparation
- Capitol Hill Healthcare Update | Gorman Health Group Blog on What Trump Could Actually Do to ObamaCare, Day One, Without Congress
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The Voice of Regan Pennypacker
10 CMS Program Audit Risks
Program audits and oversight activities must be designed with many factors to balance: accuracy, consistency, efficiency, and in an effort to be least disruptive to a plan sponsor. Correspondingly, a plan should be tailoring its response to these audits with those same factors in mind. My colleague Deb Devereaux and I outline ten common risk areas we observe in plans large and small. Read more
Three Compliance-Minded Steps to Take for 2018 Marketing and Sales
Is it me, or is time flying by? Applications are done, bids are in, new plans are in planning stages, and existing plans are getting ready for the launch of the next benefit year.
Highlights from 2017 CMS Audit and Enforcement Conference
The Centers for Medicare & Medicaid Services (CMS) hosted their annual Audit and Enforcement Conference on Thursday, May 11, and addressed the following topics: Read more
CMS Puts Plans on Notice with Recent Enforcement Actions
The Centers for Medicare & Medicaid Services (CMS) Program Audit reviews a subset of contractual requirements every year, and each year, leadership wants to know how they fared compared to others, when they are due for an audit notice, and what some of the most pervasive conditions were identified. How many of you, dear compliance-minded readers, have been asked, “What will it cost us if we stay non-compliant?” By the numbers: Read more
Adjusting Star Ratings for Audits and Enforcement Actions
Within the Draft Calendar Year 2018 Call Letter, the Centers for Medicare & Medicaid Services (CMS) acknowledged the valuable comments received from the industry related to the use of audit findings and enforcement actions in the Star Ratings Program. As a result of those comments, CMS proposes a revision of the Beneficiary Access and Performance Problems (BAPP) measure.
A Vendor’s Oversight is Never Done
There are many industry voices adding their perspectives about the new administration and changes to come. However, the Compliance Officers I know do not have the luxury of stopping and truly considering the potential impact as they are managing the continuous pressures of their daily directives. Today I address a group of very industrious Compliance professionals not often addressed, and those are the staff responsible for Compliance Programs at first tier, downstream and related entities, or “FDRs.” Under Medicare regulations, plan sponsors may enter into contracts with FDRs to provide administrative or healthcare service functions on their behalf.
2017: Taking Stock to Inform Next Steps
As the end of 2016 approached, it made for a good time to look back on developments that have impacted us over the past year. The most impactful changes related to 2016 decisions are to come, however, a few important lessons learned over the past year are worth additional reflection. This is especially true if you believe in the effects of Mercury in retrograde. Read more
