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Compliance Program Best Practices

Peggy Fry Medicare Compliance Officer. Image of Martin’s Point Health care logo. Image of beach rocky terrain. Compliance Program Best Practices. Image of Martin’s Point Health care logo. Martin’s Point Health Care . Non-profit Health Plan and Health Care provider

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Compliance Program Best Practices

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  1. Peggy Fry Medicare Compliance Officer Image of Martin’s Point Health care logo Image of beach rocky terrain Compliance Program Best Practices Image of Martin’s Point Health care logo

  2. Martin’s Point Health Care • Non-profit Health Plan and Health Care provider • Medicare Advantage Prescription Drug plan in Maine • TRICARE program in Northeast • Commercial group insurance product in Maine • Eight Health Centers in Maine, one in New Hampshire • Martin’s Point has a strong culture of “People Caring for People” 2 Image of Martin’s Point Health care logo

  3. Best Practices - Compliance Business Partner Model • MPHC employs Compliance Business Partners to work collaboratively with Operational areas • Act as advisors, not police • Educate and inform on Compliance Program and regulatory changes • Live the values and culture of the organization 3 Image of Martin’s Point Health care logo

  4. Best Practices - Medicare Compliance Committee • Chaired by Medicare Compliance Officer • Representation from all business owners that administer the Medicare Advantage program • Discuss updates and challenges, review HPMS memos • Discuss Compliance Hot Topics 4 Image of Martin’s Point Health care logo

  5. Best Practices - Other • Secret shop Marketing Seminars, Customer Service Call Center • To ensure accuracy, Compliance Business Partners audit configured benefits against EOC, SB • Perform final review of all Marketing Materials prior to CMS submission. • Review appeals, grievances and complaints (CTMs) with Operational Business Partner 5 Image of Martin’s Point Health care logo

  6. Best Practices – Other, cont’d. • Provide Compliance information during New Employee Orientation • Address current national trends in FWA prevention and HIPAA breaches • Dedicated phone line to Compliance department staff • Attend team meetings of operational departments • Conduct 1:1s with Operational business partners to foster trust, form partnerships 6 Image of Martin’s Point Health care logo

  7. Compliance Program Effectiveness • Compliance department well known and respected within company • Employees know who to call with questions • Employees feel safe in reporting incidents • Increased self reporting • Accurate and truthful monitoring reports 7 Image of Martin’s Point Health care logo

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