Posts by CODY Admin
CMS Program Audits – Preparation Is Critical
Comprehensive preparation is critical to producing accurate universes and achieving a successful CMS Program Audit. Madena’s experts have dozens of years of experience and can help Part C and D plans with all aspects of the Audit process. How Madena Can Help With Your CMS Program Audit Development and implementation support of universe design – we…
Read MoreHow to be a Rising Star—What Ratings Mean and How to Improve Them
It’s no secret that Star Ratings can have a significant impact on a health plan’s membership and bottom line. As competition increases, it’s essential to have strategies in place to elevate or maintain a 4+ star rating. The Centers for Medicare and Medicaid Services (CMS) recently released Highlights of Contract Performance in 2021 Star Ratings.…
Read MoreCODY® hires Julie Hughes as Chief Compliance Officer
Julie Hughes expands leadership position with health plan compliance expertise CODY®, a Tampa, Fla.-based healthcare technology and consulting firm, has hired health plan compliance expert Julie Hughes as Chief Compliance Officer. In this role, Hughes will lead CODY’s internal compliance program and deliver compliance consulting services to clients. She will be instrumental in working across the organization…
Read MoreCODY® CEO authors chapter in new book for healthcare compliance professionals
Deb Mabari’s chapter covers payer privacy issues in the Health Care Compliance Association’s latest edition of “Health Care Privacy Compliance Handbook” TAMPA, Fla. (Oct. 27, 2020) – Deb Mabari, chief executive officer of CODY®, a Tampa, Fla.-based healthcare technology and consulting firm, has authored a chapter in the Health Care Compliance Association’s newest edition of…
Read MoreMedicare Part C and D Data Validation Audit
Medicare Part C and D Data Validation Audits (DVA) are required by the regulations (42 CFR 422,516, 422.514, CMS-4085-F) implemented by the Centers for Medicare and Medicare Services (CMS). In order to ensure the independence of the Data Validation Audit, organizations cannot use their own staff to conduct it. Instead, Medicare Advantage Organizations (MAO) and…
Read MoreIndependent Validation Audits
What’s Possible After a Program Audit? by Sue Dahlkamp, Interim Compliance Officer & Senior Consultant CMS requires that sponsoring organizations undergo an Independent Validation Audit (IVA) if they receive a number of ICARs or CARs on their Program Audit to demonstrate correction of all reported audit conditions. CMS then determines when the audit can be…
Read MoreSix Reasons Why Consolidating Software Applications Makes Sense
In today’s rapidly changing environment, health plans operating in silos or with dated legacy systems are struggling to keep up. As competition increases and technology evolves, companies are searching for answers—should they purchase software applications individually or buy a suite or bundle? IT purchasing managers face difficult challenges as business needs grow, software solutions change,…
Read MoreThe Bridge – Volume 9
[vc_row][vc_column][vc_column_text] October/November CMS Software Release: Impacts to Plans The October CMS Software HPMS memo dated 9/1/2020 has some interesting changes, and the implementation time frames are compressed. Health plans must implement the additional data elements for Preferred Language and Accessible Format by 10/15/2020. Any new 2021 enrollment (TC61) will need to include these data…
Read MoreCan Artificial Intelligence (AI) Change the Future of Healthcare Operations?
Artificial Intelligence (AI) will become a larger factor in all facets of life soon… …in everything from self-driving cars to industrial manufacturing to the way we entertain ourselves. These changes will impact every part of healthcare also, from diagnosis through treatment and even into administrative and operational functions. CMS has started two initiatives directly related…
Read MoreCMS Skips Another Year on the MCMG
Health plans are wondering “where are my updated Medicare Communications and Marketing Guidelines (MCMG)?” For the second consecutive year, the Centers for Medicare & Medicaid Services (CMS) stated that there will be no updated MCMG for CY2021. Instead, plans are instructed to use the existing MCMG and related memos from CY2020. How will changes be…
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