CMS Star Ratings determine reimbursement rates and can ultimately determine the profitability of a Medicare Advantage program. Health plans need an experienced partner who knows how to navigate the rapidly-evolving regulatory environment. At TMG Health, a Cognizant Company, our solutions are “wrapped in compliance.” Our independent Compliance and Audit Services Department utilizes insight gained from supporting CMS health plan audits and state readiness reviews for multiple health plans in multiple states to support your team.
Our Compliance experts provide oversight and monitoring in our operational areas, internal systems configuration, processes and documentation. We also employ an Internal Audit staff and are fully compliant with SSAE 16 standards.
Our expert Medicare solutions include a host of compliance services, including:
- Tracking of CMS Guidance and Transmittals
- Proactive Monitoring of State Medicaid Contracts and Communications
- Monitoring & Identification of Risk
- Fraud, Waste & Abuse Prevention and Detection
- Federal (CMS) and State Audit Support (Internal, External, Client Delegation)
- CMS User Group Calls
- Annual Election Period Preparation Assistance
TMG Health, a Cognizant Company, is a member of the National Health Care Anti-Fraud Association (NHCAA)