Compliance and Audit

Compliance: A Complex and Ever Changing Process

Compliance with CMS’s requirements is an ongoing concern in today’s Medicare Advantage (MA) regulatory environment. Government requirements are always changing. That means continuous education and awareness are essential to ensure fast, accurate implementation as changes occur.

Let’s face the facts. Compliance is a necessary way of doing business. MMC 20/20 can help integrate Compliance into everyday workflows and processes so your Health Plan is ready for a CMS review 365 days a year.

Understanding requirements at functional and policy levels is critical to establishing an effective Compliance program. It’s also key to building an infrastructure that creates supporting policies, procedures and workflows. With today’s focus on controlling operating costs, a Compliance program that meets CMS’s requirements must also minimize the operational burdens of your Health Plan.

Regardless of the current state of your Compliance program, MMC 20/20 can work with your Plan to customize a program that will meet the requirements of CMS and satisfy the Plan’s operational needs.

We have provided assistance to our clients in the following areas:

  • Education and Communication Plans
  • Ongoing Compliance Reviews and Monitoring Tools
  • CMS Site-Visit Preparation, Including Mock Site Visits
  • Regulatory Training
  • Specialized Focus on Enrollment and Disenrollment Compliance
  • Detailed Review of Claims Payment and Appeal Systems
  • Policy and Procedure Development and Implementation
  • Development of Corrective Action Plans

Whether your Plan needs an entire Compliance program or simply requires minor changes to make it more effective, we will tailor an approach that best meets your Plan’s needs. Our consultants are experienced in identifying strengths and improvement opportunities, developing recommendations, and then assisting with implementation.

To find out more about our Compliance services, please contact one of our principals at (678) 775-1070 or