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Establishing and implementing necessary structure and procedures
Medicare Compliance Officer advice and consultation
Coordination and cooperation with in-house counsel
Ongoing consultation on a retainer basis
Updating policies, procedures, and forms to meet changing regulatory requirements
Liaison and routine dealings with CMS
Medicare Compliance and Quality Improvement Committee
Performance oversight and Reporting-Legal Issues
Fraud, Waste, and Abuse Policies and Procedures and Control Programs
CMS Monitoring and Reporting Issues
State/Federal Regulatory Issues
Establishing and implementing
necessary structure and procedures
Establishing proper structure for the Medicare Advantage Program, along with adoption and implementation of proper policies and procedures for various aspects of the Program, is essential. This includes, for example, proper structuring of the role of the Medicare Compliance Officer, the Medicare Compliance Committee, and establishment of various committees with proper organizational charters, staffing, and operations, to oversee certain critical aspects of the Medicare Program. This framework must be properly structured, implemented, and running smoothly within two calendar quarters following kickoff of the Medicare Advantage program, otherwise the program faces serious possible challenges from CMS audits and inquiries. And, once it is up and running, timely updates and modifications must be made to remain in compliance with any changes in regulations or enforcement policies.
The firm is available to provide counseling and guidance in this overall program, whether through providing templates for reporting lines and committee charters and adapting these to the particular client's needs, reviewing already adopted programs and policies and procedures for completeness and accuracy, providing ongoing monitoring and guidance, or providing guidance in updating the various programs and policies and procedures to be certain that they are current and updated as regulations change. For example, the firm stands ready to monitor regulatory changes and advise its clients regarding necessary updates to various policies and procedures, and amendments to remain in compliance with regulatory changes