Are you in control of your compliance processes?
Compliance maintenance and oversight for health plans can be a resource and time-consuming restraint. Challenges with manual processes, inefficient workflows […]
CMS Program Audit Universes as a Tool for Ongoing Compliance Monitoring
Creating the required universes for CMS Program Audit submission remains one of the most arduous and time-consuming tasks for MAPD
Americans with Disabilities Act (ADA) Changes
I attended a call recently with CMS and the ADA, CMS is looking to adhere to the Americans with Disabilities
How To Optimize your Appeals and Grievances Process?
When it comes to appeals and grievances process, most healthcare organizations struggle to improve compliance, productivity, visibility, and ratings while
Reasonable Outreach: Are you missing what CMS expects?
The Centers for Medicare & Medicaid Services (CMS) on April 20th of 2016 released several job aids in order to
2015/2016 CMS Program Audit Protocols and Process Updates
CMS program audit evaluate the performance of the Medicare Advantage/Prescription drug plans (MAPDs) and prescription drug plans (PDPs) that provide
2015 CMS Audit Protocol: Your Takeaway
In early February, the CMS released its new audit protocol and process updates for 2015 for Medicare Advantage organizations and