Medicare Compliance Programs

Health plans are required to monitor and audit their providers, business associates and downstream entities to ensure that they are in compliance with all of the requirements imposed by CMS on Medicare Advantage plans.  Too often this process is done with a mishmash of spreadsheets, e-mails and phone calls which can leave the plan exposed while costing much more than it should.

CMS requires that the plan monitor for compliance against a broad range of regulatory requirements including HIPAA, HITECH and FWA.  You already expend a great deal of effort on writing policies, training and communication.  However, the greatest challenge is in the requirement for “monitoring and auditing that includes a risk assessment process.”  Further, you must ensure a prompt response to detected offenses and develop corrective action procedures. 

An Integrated Platform

Sending spreadsheets to providers and business associates, following-up with e-mail and sharing on SharePoint both time consuming (and therefore expensive) and not very effective, but that is the approach that many plans use.  It is difficult to see your overall compliance profile, much less determine your compliance to a particular regulation or understand the real risks.  Avior’s Benchmark makes it possible to overcome these problems, by using a single business grade system with an integrated database to hold all relevant data.  This allows plans to address all regulations, automate routine tasks and show senior management the real compliance status.   

Don’t Start from Scratch

Our Medicare Advantage Knowledge Module gives health plans everything they need to for a low cost, highly effective compliance program.   Every provider, business associate and downstream entity is tracked in our database.  Our Dynamic Compliance Matrix includes all of the relevant regulations and we can add any standards or contracts that are specific to a plan.  Our assessments are built to allow you to use one assessment to cover all mandates.  The remediation module provides a tool to track issues to completion.  Finally our reports and dashboards allow you to understand your risks and always be ready for an audit. 

A Proven Approach

Our Software as a Service (SaaS) platform is being used by many leading health plans to manage these third party organizations.  Avior offers a managed service option for those organizations that don’t have the staff to manage this process directly.   We help our customers reduce cost, have better information and gets results quickly.

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