Compliance
One of our important goals at TMG Health is to make compliance “easy” for Health Plans. That is not to say that a Health Plan can delegate its obligation to adhere to the numerous requirements and regulations imposed by CMS, State Medicaid departments, HIPAA, Sarbanes-Oxley, etc. Rather, by using the long-term, broad and national experience that TMG Health brings to the table, Health Plans can more easily accommodate the requirements of administering government health products.
TMG Health’s culture is “to act like a Health Plan”. This includes our staffing of a Chief Compliance Officer, a full Compliance Department, creating a comprehensive Compliance Plan and having this plan and all compliance related activities reviewed by our Board of Directors on a quarterly basis.
For over ten years, TMG has brought to our Health Plan clients a national perspective of CMS’ regulatory activities. Because we administer over 30 Health Plans with members in all 50 States, we can offer our clients a national perspective that few individual Health Plans have. Our national perspective also includes consistent communication with CMS’ central office and monitoring of Regional Office activities and decisions.
TMG also participates in weekly CMS calls and provides call summaries to our clients. For many Health Plans that don’t have depth in their compliance department, this is a truly added value service. For others, there is the benefit of having a second set of “ears” on the call to assist in interpretation and insight.
TMG monitors all CMS Directive communications (Guidance and Transmittals) and communicates these to our clients. We prepare an Impact Statement of each applicable Directive to ensure our timely compliance with new or changing requirements. This Impact Statement is communicated to our clients to keep them abreast of their responsibilities as well as the TMG action plan in place to address the Directive. For CMS requirements that require significant resources and/or time to comply (e.g. annual Call Letter), we treat these as individual projects and assign a dedicated Project Manager. This Project Manager oversees all of the operational and IT elements associated with the requirements and ensures timely and complete adherence.
In the end, making compliance “easy” for a Health Plan means that TMG Health ensures responsiveness to volatile CMS requirements while eliminating internal resource contention.