|Software enables health plans to track/manage regulatory updates/memos|
MedHOK®, a pioneering software platform for health plans and other risk-bearing entities participating in government-sponsored programs, announced the release of the Regulatory Tracking Module, the latest addition to the MedHOK enterprise software platform. The Regulatory Tracking Module consists of a Regulatory Memo Manager and a Special Investigation (SIU) Manager, which will allow payers to manage important regulatory and compliance documents from the Centers for Medicare and Medicaid Services (CMS) within the MedHOK platform as well as document and investigate allegations of fraud, waste, and abuse.
“CMS requires that health plans thoroughly document receipt of CMS memos and guidance in all departments, as well as that policy and procedures are updated for the new and evolving regulatory compliance requirements,” said Lori Molina, Director of Compliance and Audit for MedHOK. “Plus, major new requirements for fraud, waste, and abuse documentation and investigation require plans to document and investigate such allegations. This new module replaces manual management and tracking, automates distribution, and creates a thorough audit trail.”
The Regulatory Tracking Module is a highly efficient and effective system with 90% out-of-the-box functionality, with the remaining 10% business user configurable, leading to rapid and low cost implementations. The module includes multiple intake channels and structured workflows, tasks and work queues triggered by business rules to ensure consistent application of rules and requirements.
The two functions of the module include:
- The Regulatory Memo Manager is a simple and transparent solution to receive, manage, and track regulatory updates, including Health Plan Management System (HPMS) memos. It assists in distributing regulatory updates to accountable individuals within an organization, allows for easy-to-understand action items for compliance, track and trend the types of actions required, and provides a simple way to report status to executive management.
- The SIU Manager manages and tracks investigations of compliance incidents and potential healthcare fraud and abuse. It provides a simple way to manage workloads and timeliness via customized real-time dashboards, report issues and status to executive leadership, run reports for ad hoc and immediate reporting needs, and track Corrective Action Plans. The SIU Manager creates an audit trail for each case and captures incidents, allegations, research, documentation, and tracking all within the MedHOK software platform.
The Regulatory Tracking Module includes a dashboard and Business Intelligence reporting tool for ad-hoc and immediate reporting capabilities. Access to various functions and information is user-role configurable. The Regulatory Tracking Module can be integrated with MedHOK’s Grievance Module.