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- Nancy on Making Order from Chaos
- kdambrosio on An “October Surprise” in Medicare Advantage Star Ratings
- Garth D. Weme, CIC on An “October Surprise” in Medicare Advantage Star Ratings
- Clark on Making Order from Chaos
- RP on How to Efficiently Conduct an Audit
According to Author Stephen Covey, in his book The Seven Habits of Highly Effective People, you should â€œbegin with the end in mind.â€ This means to start with a clear understanding of your destination so you know where you’re going and understanding where you are now so the steps you take are always in the right direction.
Audits from regulatory bodies swarm around an organization like bees. And like a bee, upon first sight we do not think of the value they bring, but instead we first think of the sting that is to come.
The regulatory scrutiny continues. The Centers for Medicare & Medicaid Services (CMS) 2016 Compliance and Program Audits are in full swing, and it is readily apparent plan sponsors must be â€œaudit ready.â€ CMSâ€™ intent to hold plan sponsors accountable to comply with Medicare standards and ensuring beneficiary protection is evident. Plan sponsors must be ready to take the test.
Have you ever received a gift you knew had value, but you just werenâ€™t sure how to use it to its full potential? Complaints are very much like that. We need to change our view of complaints and consider them to be gifts from our members that need to be opened and cared for as the important pieces of information they are. Complaints are something we all wish would never be needed, but every health plan receives them. Our members have needs, and sometimes those needs donâ€™t appear to our members to be met. In those instances, if we are lucky, the health plan receives the complaint. If we are not lucky, our membersâ€™ neighbors, acquaintances, doctors, or even worse â€’ regulators and congressional representativesâ€™ â€’ receive the complaint.
On June 16, the Centers for Medicare & Medicaid Services (CMS) held their third annual Medicare Advantage & Prescription Drug Audit and Enforcement Conference and Webcast. At the heart of this conference is the CMS Program Audit. Agency experts as well as Sponsor participants presented to an in-person and webcast audience on expectations, process enhancements, upcoming developments, and more.
Do you think the Centers for Medicare & Medicaid Services (CMS) program audits are stressful? We often make it worse for ourselves than it already is. Imagine being in the audit webinar pulling up a case and having CMS say that case was to be excluded from the universes. Instead of showing your department, processes, and system capabilities, CMS is getting the impression you donâ€™t even know your data well enough to pull a correct universe. What can Operations departments do to get ready? Here are four things you can begin doing today to be ready: Read more