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Press Release: MedHOK Adds Regulatory Tracking Module to Healthcare Enterprise Software Platform

Press Release: MedHOK Adds Regulatory Tracking Module To Healthcare Enterprise Software Platform

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.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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