Posts Tagged ‘risk management’
CMS Audit Updates—Proactive Steps to Ensure Readiness & Maintain Compliance
Success in any CMS audit depends on being prepared to ensure readiness and maintain compliance throughout the year. Taking proactive steps now to support future CMS audits will produce better results and experiences for health plans and create a greater level of confidence for participants. New Audit Protocols for CY2022 Earlier this year, CMS released…
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 More3 Keys to a Successful Compliance Program
Complying with state and federal rules and regulations is a challenging endeavor. It requires health plans to manage a slew of different processes and resources. Missteps pose risks that could result in compliance violations, fines and a drop on CMS’s Five Star Quality Ratings. Some of the most difficult areas to manage, from a compliance…
Read MoreHow Medicaid Plans can Prepare Compliance Efforts for Increased CMS Oversight
The writing is on the wall. There are well-documented issues of a lack of uniformity and accountability surrounding state Medicaid programs. Understanding CMS’s history of recognizing problems and acting to find solutions, it stands to reason the agency will, in the future, establish compliance programs for state Medicaid plans that mirror those of Medicare. When…
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