How do you work with contracted care management vendors to effectively manage member care?
Furthermore, how do you ensure that you are only working with FDRs that can meet CMS compliance requirements?
Medicare Advantage (MA) plans work with a broad range of FDRs. Some are Accountable Care Organizations (ACOs) while others are vendors offering services such as utilization management, case management, health reimbursement arrangements (HRAs), STAR gaps-in-care closure, and behavioral health. CMS recently expanded the definition of supplementary benefits, adding various and diverse service providers to the mix.
With so many organizations involved in care, major challenges arise. One of the biggest road blocks is trying to figure out if the services delivered by these FDRs meet your requirements. Additionally, it is difficult to confirm that they are compliant—which is imperative—because the consequences of noncompliance can be significant.
Ensuring compliance can positively impact your organization by avoiding:
- Corrective action plans.
- Civil Money Penalties (CMPs).
- Intermediate sanctions.
- Immediate termination of CMS contracts.
View this webinar from ZeOmega® to learn how innovative population health management (PHM) solutions can help you get what you want, and need, out of an FDR.
Hear industry thought leaders discuss how a comprehensive care management platform for data integration/sharing, timeline monitoring, co-management, communications and reporting can help MA plans work with FDRs more effectively. With the right solutions, delivering improved care and services becomes easier while ensuring CMS compliance becomes more straightforward.