Professional Medicare Advantage Monitoring to Ensure You Are in Compliance!

If you are a healthcare provider or medical facility that receives government reimbursement through Medicare or Medicaid, you can be subject to audits and investigations from each of these agencies. 

When Medicare conducts an audit or investigation and finds out that certain areas of your entity are not in compliance with healthcare laws, rules, and regulations, you will be required to create and implement a corrective action plan (CAP). 

It is done to ensure that you can continue doing business while assuring that prior violations or illegal conduct do not continue to occur in the future. If you want to avoid being found violating any medicare rules and regulations, it’s best to rely on a professional medicare consultant for Medicare Advantage monitoring. 

He/She will thoroughly monitor the activities in your facility and inform you immediately if anything is against compliance. You can also expect your Medicare Advantage monitoring consultant to provide you with practical solutions to meet the regulations set by Medicare. 

Actions a professional Medicare Advantage monitoring consultant may take:

    • Ensure that all workers in the healthcare facility have completed fraud, abuse, and waste compliance Medicare Advantage training annually and maintain the documentation of this training. 

    • Ensure that your facility has a legitimate policy and processes for screening all newly joined employees upon hiring and against GSA and OIG exclusion lists annually. 

    • Conduct internal mock audits in your facility. This mock audit is a  part of Medicare Advantage monitoring that ensures everything runs smoothly in your practice when it is time for an actual audit from Medicare.

Benefits of regular Medicare Advantage monitoring

The Center for Medicare & Medicaid Services (CMS) contracts with private Medicare Advantage organizations to offer healthcare coverage to Medicare beneficiaries. CMS pays MA organizations a fixed amount per beneficiary to provide efficient and affordable care. 

CMS oversights these organizations to ensure they are not misusing this incentive through occasional audits. It is essential to provide proof of the finest care at your facility to your sponsor. 

Regular Medicare Advantage monitoring ensures that everyone in your healthcare facility is working optimally and also keeps a record of it to present to CMS during an audit. 

Final thoughts

A Medicare compliance expert can help you develop procedures to monitor your compliance issues. It can include routinely evaluating your organization's employee training for safe and effective clinical practices. 

In addition, your organization must review Medicare Advantage claims and billing practices for your policies. Your medicare compliance expert can also determine whether a formal internal audit is required.