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Focus Area: Medicare
Many health plans and payers participate in a Medicare Advantage, Medicare Advantage Part D (MA-PD) or Special Needs Plan (SNP). As the Medicare eligible population grows, so do the requirements for compliance and operations defined by the Centers for Medicare and Medicaid Services (CMS). To support health plans and BPO organizations in navigating the complex Medicare environment, HTMS offers the following services:
- Medicare operations support and compliance assessment
- CMS mock site visit or mock audits - including Compliance Plan and Performance Audits
- Fraud, Waste and Abuse Program Operations Assessment
- Medicare training workshops
- Interim staffing for key Medicare executive positions
- Medicare Advantage implementation
- Medicare compliance strategy, execution, and support
Medicare Accountable Care Organizations (ACO) - With the creation of new Medicare Shared Savings Programs, many clients are seeking information for the development of strategies, operations, certification and implementation of an Accountable Care Organization. HTMS offers the following services:
- Initial presentation on ACO strategy
- Detailed assessment of organizational readiness for ACO participation
- Operational Support to apply for ACO certification
- Support for ACO Implementation and Operations
HTMS has partnered with a client to develop a compliance strategy to ensure a process for monitoring regulations changes, understanding how regulation changes affect business and implementing changes where appropriate.
