The Voice of Regan Pennypacker

Regan Pennypacker

About Regan Pennypacker

Regan brings to Gorman Health Group clients more than a decade of operational and compliance expertise in Medicare Advantage and Part D. In her role at GHG, she assists health plans with audits, gap analyses, and plan implementation by creating policies, workflows and marketing materials. Her expertise also extends to providing detailed training for compliance and operations, specifically in grievances, appeals, and compliance auditing. Read more

Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight

Regan Pennypacker

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.

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Countdown to Final Submit

Regan Pennypacker

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

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2016 CMS Applications: Highlights and Basics

Regan Pennypacker

This week’s CMS industry training on applications was quite informative, and contained many audience questions that you will want to hear.   The recording is already available to registrants for those who missed it.  There was way too much information for me to summarize, so I have included here a few highlights from the call and some basics that are easily overlooked.

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2016 CMS Application Season Begins

Regan Pennypacker

Yesterday CMS released the 2016 Part D application, and this afternoon the 2016 Medicare Advantage (MA) application was released.  Despite the applications’ release dates, potential and current Plan Sponsors should be well under way in the preparation of the upload that is due on February 18th.  Aspects of the application that require significant lead time to accomplish include the establishment of an adequate network and the acquisition of the required state licensure.

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4 Points to Ponder from CMS’ Oversight and Enforcement Conference

Regan Pennypacker

On June 26, CMS hosted their MA-PD Oversight and Enforcement conference. Not one of the topics was less relevant to the audience than another – they prepared ahead of time to present current, critical information related to their data-driven approach to oversight, best practices and common findings, preparing for an audit and enforcement actions. I was glad to see CMS invite plan sponsor staff to share their experiences. They included Todd Meek of SilverScript Insurance Company; Margaret Drakeley of Kelsey Care Advantage; Shannon Trembley of Martin’s Point Health Care; Marcella Jordan of Kaiser Permanente, and Jenny O’Brien of UnitedHealthCare. Their first-hand accounts are worth your full attention.

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Integration of MMP Requirements

Regan Pennypacker

MA-PD plans have plenty to worry about with CMS requirements, regulator’s issue of the day, or Central Office determining what issue to hang their hat on today, seemingly changing with the shift of the wind. It is a challenge to keep track of it all, but it’s a necessity we promote and support.

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Innovating in 2014

Regan Pennypacker

CMS has developed an Innovation Center to address health care payment and service delivery models. It is a great site to find information about current Innovation Model Partners, and a place to share your ideas on how care can be delivered and paid for in ways that will lower care cost and improve quality of care. As always, the service to beneficiaries is at the heart of these initiatives, and for the program to continue, partners must be innovative.

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