Our Government Program services are under the leadership of Wendy Weingart (MS, RPh) Senior Vice President, Managed Care Services, Lisa Howard (BS, CPM, CHP) Senior Vice President, Medicare Compliance, and Maureen Miller BSN, MPH), Senior Vice President, Government Programs.
This practice group includes consultants with previous experience as CMS specialists, health plan operations, as well as those with clinical backgrounds. All have health plan , Pharmacy Benefit Manager (PBM) operations, or health insurance experience including compliance and related information technology applications. Our team is prepared to work side-by-side with clients to quickly and efficiently assess current operations and compliance status, identify areas of potential areas of risk and provide actionable recommendations that match specific program needs. Use this link to download more information about Visante Services for Plan Sponsors.
RESOURCE PAGE of Visante’s Government Programs Consulting Experience.
Audits and Assessments
Using structured processes that are customized to match each plan’s specific operational setup, Visante provides gap assessments, CMS mock audits and focused audits for each operational area as well as for the overall Compliance Program. We also review end-to-end processes with risk stratification and recommend best practices based on established industry standards.
Some Common Requests for Audit Services
- Audit validation support to verify plans have corrected CARS and ICARS
- Coverage determinations, appeals and grievances (CDAG)
- Organization Determinations, Appeals & Grievances (ODAG)
- Compliance (CPE), including first tier, downstream and related entity (FDR)
- Formulary and benfit administration (FA)including transition fills
- Rejected and paid claims analyses
- Employer group waiver plans(EGWP)
- Special needs Plan Model of Care (SNP MOC)
- Medication therapy management (MTM)
Visante consultants have in-depth experience assisting Plan Sponsors and Pharmacy Benefit Managers through the audit process. Clients have often referred to our consultants as their most valuable resource when preparing for a CMS audit. We will help with assessing audit readiness as well as any required remediation or follow-up upon conclusion of an audit.
- Operational assessments
- Quality improvement and best practices (Stars)
- Health insurance exchanges (HIX)
- Dual Eligibles: Medicare and Medicaid
- Interim staffing and training
Medicare Strategic Review
Visante offers an on-site, high level Medicare Strategic Review to help client leadership create a strategic approach specific to their company’s needs. Using our knowledge of CMS priorities and industry standards and best practices, we have developed a risk assessment tool with a Strategic Review Scorecard measuring key areas that are critical to CMS compliance in an audit and identifies operational areas of greatest exposure. The assessment is quick, usually lasting 1 to 3 days, and is followed by a detailed report within two weeks containing our findings and recommendations.
Ad Hoc Operational and Compliance Support
Visante’s Government Programs consultants also provide a variety of services to Plan Sponsors on an ad hoc basis for small projects. Our Ad Hoc Operational and Compliance Support services are particularly helpful when a client needs expertise for a small number of hours, such an answer to a quick question, some research or a request for a small project. This has been lauded as a critical service for plans with fewer resources, yet are responsible for being compliant with all CMS requirements.