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- INOC | NOC for Data Center on Network Adequacy Test Submissions for Medicare-Medicaid Plans
- Raji on Obamacare Reinsurance and Risk Adjustment, Year One.
- Brian Krantz on What a Difference a Year Makes
- Gorman Health Group on Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight
- Liz Robinson on Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight
The Voice of Regan Pennypacker
As we wait for the 2014 Part C and Part D Program Annual Audit and Enforcement Report to be released, we contemplate the activity that our client partners have experienced during CMS audits, in remediation of identified conditions, and preparation for future activities.
The pessimist complains about the wind. The optimist expects it to change. The realist adjusts the sail. -William A. Ward
Some important points came out of the Centers for Medicare & Medicaid Services’ (CMS’) Medicare Advantage Prescription Drug (MA-PD) Spring Conference & Webcast; the presentations and videos of the event can be found here in CMS’ Event Archives. If you did not have a chance to attend or watch it live, please watch the videos for important changes pertaining to many aspects of the MA-PD program. Speakers addressed Part C and Part D call letter updates, policy and technical changes, Quality Improvement Project (QIP) and Chronic Care Improvement Program (CCIP) lessons learned and best practices, the new network management module, enrollment updates, and fraud, waste, and abuse (FWA).
Spring is here, showing us all different signs of renewal. It motivates us to clean out clutter, open those windows, and start the year fresh. Audit season is also upon us, and people are taking a close, hard look at internal processes that surround grievances and appeals processing. Findings in this area keep showing up, like that college grad that keeps popping in to visit his friends back on campus. Just leave already, you’ve had your time!
“Do It Yourself”, or DIY, has been the rave for years now. From social media sites like Pinterest to television networks like HGTV, Americans have become fond of this philosophy. Now, I am a big believer in being self-sufficient and must say that I have been sucked into marathon viewings of DIY shows often (Nicole Curtis of Rehab Addict is no joke!). And, while I have seen my share of success stories, more often than not, I see DIY projects result in complete frustration from those attempting to DIY and very costly mistakes.
There is no shortage of concern when it comes to awareness of first tier, downstream and related entity (FDR) oversight. In fact, during a recent webinar hosted by John Gorman, Executive Chairman at GHG, and Betsy Seals, Chief Consulting Officer at GHG, on “The Top 10 Things Killing Your Organization”, we shared survey results showing the number one Compliance Program risk, from a health plan’s perspective, is FDR oversight.
Today is the final day for current or potential plan sponsors to submit their Medicare Advantage and/or Part D application for a new contract or service area expansion (or service area expansion for 1876 Cost Plans). By now, many of you have already hit final submit and are either celebrating or working on known deficiencies. Or, perhaps you are still waiting for documentation or a final quality check of your submission before you feel confident to submit. Here are a few of the things we learned this year along the way. Read more