Managed Care Compliance

Description

Guiding Star: Navigating NCQA Revisions

Keeping up with NCQA accreditation standards is vital for successful enrollment with managed care organizations, especially in light of the latest revisions. Join TMG and explore the newest changes to the NCQA credentialing standards and their potential impact on your operations. Gain insights into how these revisions reflect current healthcare trends and learn strategies to stay compliant while enhancing your organization’s quality of care.

Objectives
Describe the most significant revisions to the NCQA accreditation standards.
Explain how these changes align with current trends in healthcare, such as patient-centered care and digital health.
Identify actionable strategies to implement the new standards effectively and maintain compliance.

Acing the Audit: Avoiding Common Deficiencies

Stellar managed care credentialing helps ensure quality care, patient and physician satisfaction, and cost management, but mistakes can happen. Join TMG in examining steps to take before, during and after an audit, recognizing the most common deficiencies in the audit process, and identifying corrective actions.

Objectives:
Identify 7 common audit deficiencies
Explain the accepted sources and time frames for appropriate verification/attestation
Describe the appropriate documentation to ensure compliance

Emerging Issues: Ongoing Monitoring & System Controls

Ongoing monitoring and credentialing system controls are increasingly important in the managed care environment. Join TMG in exploring requirements for the frequency of monitoring, acceptable sources, and credentialing system controls monitoring and reporting requirements to ensure the accuracy, completeness, and confidentiality of credentialing information.

Objectives:
Explain the 3 factors for ongoing monitoring compliance
Identify acceptable sources and frequency for ongoing monitoring
Define the 5 factors for credentialing system controls monitoring and reporting

Verification Station: Managed Care Compliance Across Accreditors

There are subtle and not-so-subtle differences among CMS, NCQA, and URAC verification standards. Join TMG to understand the nuances of the information that needs to be verified, acceptable sources outside of the primary source, required documentation, and verification/attestation time frames.

Objectives:
Describe the difference in verification requirements between physicians and APPs
Explain accepted verification sources for each accrediting body
Identify the verification/attestation time frame for each accrediting body