Rise Health

Identification: TUE01

Identification: TUE02

Learning Objectives:

Comb through your current universes to discover inaccuracies related to CMS requirements for ODAG and CDAG universes and tables
Create and implement new approaches to universe construction to avoid pitfalls in the future
Monitor universe accuracy on a monthly basis through universe pull and inspection to find errors

Identification: TUE03

Learning Objectives:

Incorporate monthly education practices for all FDRs that highlight the expectations of the FDR, communication best practices, and documentation
Include FDRs in all mock audits in preparation for the CMS Audit and incorporate feedback into training exercises in areas to improve
Generate a strong partnership by understanding what your FDRs are dealing with and how you can help them achieve goals for both entities

Identification: TUE04

Learning Objectives:

Assess how the CMS TMP will affect your operation and what you need to do in advance to be prepared
Formulate a plan to perform reviews of your current systems, evaluate accuracy within your universes, analyze your timeliness standards related to CMS guidelines, to determine current benchmarks
Bridge the Gap: Create a plan of action on how you can improve current benchmarks, including evaluating vendor solutions that can guide you through the process

Osato F. Chitou, Principal Consultant, NMOC Healthcare Compliance Consulting d/b/a Compli by Osato

Identification: TUE05

Learning Objectives:

Identification: TUE06

Learning Objectives:

Examine how root cause analysis of 1-800-Medicare CTM cases can have impact on member experience
Discuss the continuous improvement cycle needed in order to maintain Complaints About the Health plan STAR metrics and beyond
Establish and discuss best practices for documentation and casework handling to drive stellar performance

Nicole Henderson, MBA, Manager, Operations Quality & Compliance - Regulatory Complaints, Blue Cross and Blue Shield of North Carolina

Identification: TUE07