Chief Compliance and Ethics Officer Health Care

CTMs - Determining Risk

  • 1.  CTMs - Determining Risk

    Posted 03-27-2019 12:49 PM
    With regard to complaint tracking through HPMS, I know CMS reviews # of complaints per 1000 members, which then determines your outlier status in comparison with other plans.  It's been my experience that plans aren't aware they are an outlier until receiving notice from their account managers.  Is there a better way to work the formula yourself to determine when you may or may not be reaching that outlier level?  Any insight or advice would be greatly appreciated.

    Thank you,

    Nichole Hageman
    2019 HCCA Compliance Institute