Typically, a letter announcing the intention of an audit is sent to the company. However, I have experienced where State Agents came directly into a clinic and started the investigation immediately on premises. In this case, the investigation was based on a complaint issued to the State Medicaid agency. Having Federal and State Agents come […]
Category: OPERATIONS
Ways a Health Plan Audit Can Be Initiated
There are several ways that a Health Plan audit can be initiated: As a result of pre-delegation audit and annual audit findings From a delegation/contractual standpoint, there can be Key Performance Indicators (KPIs) that must be met for a health plan to remain in compliance with the Centers for Medicare and Medicaid Services (CMS). For […]
US Department of Labor announces enforcement, effort for focused inspections in hospitals, nursing care facilities treating COVID-19 patients
For two years, millions of the nation’s healthcare workers have been battling the coronavirus. Many have endangered themselves as they care for those who contract COVID-19 while working in high-risk settings that expose themselves and their families.
Personalized healthcare driven by an explosion of patient needs
Rich Corbridge, CIO at Boots UK and Ireland, discusses how the pandemic transformed clinician and patient attitudes toward technology and how digital tools can help improve personalized healthcare.