Neglecting the importance of compliance is not sustainable on the part of a health plan or a solution provider. With both public and financial implications in place to protect the integrity of government-sponsored health plans, oversight requirements are an absolute necessity. To prevent exposures that could place them at risk, health plans and their solution providers must be equipped to not only interpret and understand the compliance guidelines and regulations but also demonstrate preventive measures to react to and implement changes.
A compliance culture ingrained within an organization is the first step to minimizing this risk and reducing shortfalls in meeting the Centers for Medicare & Medicaid Services (CMS) standards. Further, a compliance culture can support increased ratings for the health plan. Both of which create a competitive edge for a health plan, leading to enhanced benefit offerings, improved member retention, and membership growth.
Having a First Tier, Downstream or Related Entity (FDR) partner, who maintains a well-established, well-organized compliance team tailored to CMS regulations, has been a key trait for those growing within the government markets. By combining partners that provide built-for-purpose technology, a concentration of industry experts and advisors, and a robust compliance framework, the health plan is far better equipped to navigate through the turbulent regulation landscape without fear or risk. With government sponsored specific technology and expert industry advisors built on a robust compliance framework, the health plan can navigate the turbulent landscape with a competitive advantage.
Learn more about Convey's healthcare compliance software solution, OMT.
Convey, and its family of companies, has developed and evolved a comprehensive and robust compliance program embedded at all levels to effectively monitor, interpret, and train on the regulatory requirements necessary to support the work performed on behalf of health plan clients. Convey’s culture of compliance demonstrates its commitment to honest and ethical conduct, as well as reflects Convey’s effectiveness in identifying and reducing risk, improving internal controls, and establishing standards that align with each health plan’s needs. Led by a chief compliance officer and in partnership with our learning and development department, Convey invests in education, training, monitoring / auditing and communication around compliance all to reduce risk.
A proactive and transparent approach to compliance will assist in more focused initiatives around growth and profitability, which health plans should consider when looking to FDR’s. Technology solutions, and the experts behind the technology, should all share the understanding of, commitment to, and investment in compliance. With Convey, this has been the culture and approach since 2001.
Policy: Convey has adopted a Corporate Compliance Program (Compliance Program) to reaffirm Convey’s commitment to promoting full compliance with applicable local, State and Federal laws and regulations, and Federal Health Care program requirements. The Compliance Program utilizes the CMS Chapter 9/21 of the Medicare Prescription Drug Benefit Manual and Medicare Managed Care Manual/Compliance Program Guidelines as a solid framework for structuring a comprehensive range of compliance activities designed to avoid legal and ethical problems.
Legal Basis: Convey’s Compliance Program has been developed in accordance with applicable law, and with guidance from federal authorities, including the United States Federal Sentencing Guidelines, and the Centers for Medicare & Medicaid Services (CMS) Guidelines and the Health Insurance Portability and Accountability Act (HIPAA). The scope of the Compliance Program may be expanded in the future to cover additional areas of regulatory compliance to which Convey is subject.