decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Managed Care Model Compliance Plan / Data Collection and Submission Processes
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Article Overview
This premium article explains the compliance framework for Medicare managed care plans’ data collection and submission processes. It focuses on the general requirements for accurate, timely, and complete reporting to CMS, the certifications tied to payment-related submissions, and the types of internal controls and oversight concerns highlighted by OIG. The piece is relevant to compliance, managed care operations, reimbursement integrity, and organizations responsible for plan reporting and certification.
Why This Topic Matters
Accurate managed care reporting affects payment, compliance risk, and potential civil or criminal exposure. The article helps readers understand the broader regulatory and oversight context surrounding data integrity, internal controls, and CMS submission processes.
What You Will Learn
- The general compliance expectations for managed care plan data collection and submission
- How CMS-related reporting and certification processes fit into Medicare managed care oversight
- Why internal controls and verification practices matter for plan-reported data
- Which broad areas of managed care reporting have drawn OIG concern
Who Should Read This
- Compliance officers
- Managed care administrators
- Health plan executives
- Revenue cycle and reporting teams
- Medical coding and reimbursement professionals
Codes Discussed
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