The Voice of Regan Pennypacker

Regan Pennypacker

About Regan Pennypacker

Regan is Senior Vice President of Compliance Solutions at Gorman Health Group (GHG). She leads the Compliance Solutions practice, responsible for multidisciplinary projects such as Part C and Part D audits, new applications, marketing material reviews, risk assessments, and training engagements. As a member of this team, she has provided compliance direction and insight on industry best practices to dozens of GHG clients. Regan brings GHG clients 17 years of experience in the healthcare industry. Read more

To File or Not To File, That Is the Question

Regan Pennypacker

We’ve made it clear through this blog the Centers for Medicare & Medicaid Services (CMS) is throwing down the gauntlet in terms of ensuring Medicare Advantage provider networks are adequate. The biggest change to the 2017 application process supports this initiative. For Service Area Expansions, CMS is requiring current service area network data at the contract level in addition to the pending service area data. Previously, CMS requested only those providers supporting the pending counties. Applicants took to the CMS User Calls to ask clarifying questions about this requirement, including a number of “what if” questions, indicating that applicants either know they have unknowns in their networks, or they know how their network fares and they want to know the consequences. In addition to some provider network documentation changes, here are some other notable changes to the application process: Read more

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Three Reasons Why Compliance Program Effectiveness Needs Evaluation Now

Regan Pennypacker

Happy New Year! It’s a time when your organization may be evaluating whether or not to submit a new application or a service area expansion. This may be when annual training kicks off once again. You may be reviewing attestations to determine which vendors need to provide you with new documentation.  And don’t forget to ensure the Claims Department has updated systems to reflect the current prompt payment interest rate.

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CMS Clarifies Key Audit Terminology

Regan Pennypacker

Immediate Corrective Action Required (ICAR), Corrective Action Required (CAR), and Observation. These terms have become part of the vocabulary for Compliance specialists, auditors, analysts, managers, directors, and Compliance Officers who so often field questions from Operations. Let’s consider the following scenario: Compliance has just completed an internal audit of Claims Operations and has identified findings. This leads the Ops team to ask, “Are these findings CARs or ICARs?”

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Evolution of Validation: Selecting an Independent Auditor

Regan Pennypacker

The Centers for Medicare & Medicaid Services (CMS) audit validation process has evolved over the past few years. Here is what you should know about the changes and how to best prepare to contract with an Independent Auditor, or IA.

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2015-2016 CMS Program Audit Protocols Update

Regan Pennypacker

It’s Christmas in October (and Hanukkah, too) if you’ve been waiting for the revised 2015-2016 Program Audit process and protocols. Let’s get right down to it!

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The CMS Fall Conference: 4 Ways to Solve the Preparedness Problem

Regan Pennypacker

The Centers for Medicare & Medicaid Services (CMS) held their Fall Conference and Webcast on September 10 in Baltimore.  The presentations and videos from the event are found on the Compliance Training, Education & Outreach site here.  CMS covered various aspects of the Medicare Advantage Prescription Drug (MA-PD) program, but here I’ve focused on four lessons I heard loud and clear: work with CMS, prepare ahead of time, seek continuous improvement, and don’t wait until the last minute.

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Potential Changes in Part C Reporting

Regan Pennypacker

The Part C and Part D Reporting Requirements and Supporting Regulations were posted in the PRA Listing on August 24th for review and 30-day comment. Since we are still in this window, this is a great opportunity for Compliance and Operations to review these together. To follow are Part C highlights that merit your attention.

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