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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
In sports, a good coach will tell you, “Practice like you play, because you will play like you practice.” Well, the same can be said for case sampling. My colleague, Anita McCreavy and I advise plans, “You can use an audit practice run of your Model of Care’s Special Needs Plan Enrollees (MOC-SNPE) universe to tell you if your operations are ready for a Centers for Medicare & Medicaid Services (CMS) audit.” Additionally, there is opportunity to add to the universe fields to assist management in further prioritizing potential gaps.
Many organizations find accreditation and certifications to be a requirement in a standard book of business. They provide a roadmap for your organization to be clinically sound, quality driven, and integrated. These accreditations assist organizations in demonstrating to their customer’s compliance with regulatory standards and a fundamentally sound structure.
I am continually amazed by how many health plans in Medicare Advantage (MA) and Medicaid still cling to restrictive, “Dr. No”’90’s-style managed care practices like pre-authorizations, referrals, and concurrent review. With massive policy changes looming in Medicaid, and the influence of Star Ratings in MA greater than ever, health plans may soon have a gun to their heads: evolve medical management from restrictive to supportive, or die.
While headlines rage in DC about Trump’s leaks to Russian spies visiting the White House last week, the Senate’s sausage factory grinds away on TrumpCare. You’ll recall following House passage of the American Health Care Act (AHCA), the Senate essentially declared it DOA in the upper chamber and started over. Health plans are in the middle of bid development for the ObamaCare Marketplace and for Medicare Advantage and Part D, so timing and details matter.