Deep expertise for better management of complex government health programs
Our government unit helps health plans navigate the maze of Medicare and Medicaid compliance requirements and ensure evidence-based, affordable care for their beneficiaries. Count on our uniquely qualified team, led by Jennifer Eklund, MD, to extend your internal resources for superior management of the complexities of government health programs.
Our depth of government experience helps you stay ahead in a constantly evolving landscape and supports positive Centers for Medicare & Medicaid Services (CMS) star ratings. We routinely monitor CMS updates and ensure quality and compliance through documented CMS-focused training and auditing procedures.
Anchored by our proprietary, technology-driven clinical review process that incorporates both national and local coverage determinations, our solutions align with both state and federal mandates.
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A focused approach to government programs
We use a multifaceted approach to help you meet government requirements and guide your beneficiaries to appropriate, safe, and affordable care. In addition to our review process and support programs, we also provide data-rich insights on program performance and practice trends.
- GOVERNMENT-TAILORED CLINICAL APPROPRIATENESS REVIEW
- STATE AND FEDERAL COMPLIANCE PROGRAM
- AUDIT SUPPORT PROGRAM
- CONSULTATION FOR FAIR-COVERAGE HEARINGS
- CMS MONITORING
- PROGRAM PERFORMANCE AND PRACTICE TRENDS REPORTING