About this webinar
DELEGATION OVERSIGHT SOLUTION
Manage first-tier, delegated and related entities (fdr) to ensure compliance. Whether to gain expertise, reduce administrative costs or increase capacity, a Medicare Advantage plan sponsor may opt to outsource administrative functions. When they do, regulatory agencies like the Centers for Medicare & Medicaid Services (CMS)—as well as accrediting bodies, like the National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC).
Plan sponsors—which can be employers, unions or health insurance carriers—must meet NCQA standards and demonstrate they haven’t compromised the ability to evaluate structures and processes that achieve consistent, high-quality performance across its network and memberships. The same applies for managed care organizations (MCOs), health plans that accept a set payment per patient per month, known as capitation; MCOs must demonstrate an ongoing oversight function to ensure continuous compliance is achieved for all delegated activities. Often, this is a labor-intensive process, requiring many reports and audit results to manage.
Don’t miss this opportunity to engage with Review of the CMS 2016 Reporting Changes Affecting A&G.