decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Managed Care Model Compliance Plan / Disenrollment
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Article Overview
This premium article addresses managed care plan compliance issues surrounding disenrollment, including the legal and regulatory framework, oversight concerns raised by the OIG, and the need for internal policies that govern when enrollment-related discussions may occur. It is intended for compliance professionals, healthcare administrators, managed care organizations, and coding or reimbursement staff who need to understand the broader regulatory context affecting plan operations.
Why This Topic Matters
Disenrollment practices can have major compliance and payment implications for managed care organizations, making it important to understand the governing rules, enforcement risks, and policy expectations discussed by oversight agencies.
What You Will Learn
- The general compliance framework surrounding disenrollment in managed care plans
- Why oversight agencies have concerns about inappropriate disenrollment practices
- How federal requirements relate to plan policies on beneficiary communications
- The role of internal procedures in preventing improper disenrollment activity
Who Should Read This
- Compliance officers
- Managed care organizations
- Healthcare administrators
- Reimbursement and billing staff
- Health plan operations teams
Codes Discussed
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