Topic: Compliance

The Imminent Medicaid Mega-Reg is Gonna be “Epic”

John Gorman

For the last several weeks health policy nerds have been anxiously awaiting the release of the long-awaited Medicaid managed care proposed rule, the first from the Centers for Medicare and Medicaid Services (CMS) in 13 years. We’re coming to call it the “mega-reg” here.  Friday at the Congressional advisory MACPAC meeting, Commissioners were widely quoting  the term “epic” used by Jeff Myers, CEO of Medicaid Health Plans of America, in a recent National Journal article.

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Five Critical Steps to Enhance Revenue & Maximize Growth Potential

Glenn Ellerbe

Everybody’s talking about revenue management and maximizing growth opportunities for health plans, but no one has laid out the steps for successful outcomes…until now.  Gorman Health Group (GHG) is giving you our recipe for enhancing your premium revenue and maximizing your growth potential in the following five-step plan:

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19 Lessons from 19 Years

John Gorman

Nineteen years ago this week, I left the Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS) and the Office of Managed Care, to launch what would become Gorman Health Group.  Time has flown, the company has grown, and my backside sewn with hard lessons about our industry and government health programs.  Here are 19 lessons I’ve learned in those 19 years. Read more

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Spring Fever Focus: Grievances and Appeals

Regan Pennypacker

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!

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Gorman Health Group Client Forum Takeaways: Government Programs are Booming, Bar is Rising

John Gorman

We just wrapped our best-ever Gorman Health Group 2015 Client Forum at National Harbor with over 200 of our closest clients and partners.  There was both great and tough news, so here’s a few takeaways, including a couple stunners: Read more

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The Risk in DIY: CMS Mandated Material

Regan Pennypacker

“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.

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Go-to-Market – No Department Left Behind

Charro Knight-Lilly

Although the next Annual Election Period (AEP) is a ways off, now is the time to start thinking about product development and overall strategy. In most organizations, the start of the “Go-to-Market” (GTM) strategy discussions begins with the C-Suite, Product Development, and Sales and Marketing.  This keen group of professionals works sequestered and siloed for a period of time and then, voilà, they emerge with the lifeline of the health plan’s benefits and strategy in their hands.

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