Managed Care Engagement Team

JDJD

“It is an exciting time to start a career in health care. Our health care delivery system is constantly evolving and managed care is a leading force in that change.” Bob Bullen, CPA, member and Co-Partner-in-Charge of the Managed Care Team

“The opportunities that are available in this area to graduates are particularly exciting due to the combination of growth and change in the industry.” Michael Johnson, CPA, CFE, member and Co-Partner-in-Charge of the Managed Care Team

Who We Are

The managed care engagement team is made up of auditors, analysts, pharmacists, nurses and compliance specialists and has been providing managed care audit and consulting services to Medicaid programs for over 10 years. In addition to our work with state Medicaid programs, we are also recognized nationally for our federal work with the Centers for Medicare & Medicaid Services involving Medicare Parts C and D.

Client Sample
  1. Centers for Medicare and Medicaid Services
  2. Georgia Department of Community Health
  3. Louisiana Department of Health and Hospitals
  4. Maryland Department of Health and Mental Hygiene
  5. Nevada Department of Health Care Financing and Policy
  6. South Carolina Department of Health and Human Services
  7. Texas Health and Human Services Commission

What We do

The managed care engagement team’s services are designed to address the entire evolution of a managed care program and includes both attest and non-attest services. These audit and consulting solutions are designed to help states and CMS enhance their ability to monitor managed care health plans and ensure compliance with federal, state and industry standards. Our services include:

Implementation Consulting: we help clients identify program risks, determine the resources necessary to manage the programs, and figure out the when/where/why/how to deploy those resources to maximize the efficiency and value of the program.
Health Plan Encounter, Claims and Other Data Verification: we help clients ensure that the vast amount of data generated and used by their managed care program is accurate, the reported costs are allowable, the profits are accurate and reasonable and that operations are meeting contract performance standards.
Contract Compliance: we help clients ensure that MCOs are following contract requirements and providing enrollees with the services expected.
Rate Setting: we help clients ensure that the encounter and other financial data utilized for capitation rate development is complete and accurate.
Health Plan Quality and Access: we help clients ensure that MCOs are providing enrollees with access to the services they are entitled.
Program Integrity: we assist clients with strategies to identify, detect and prevent fraud, waste and abuse within their managed care programs.
Federal Financial Participation Consulting - We assist clients with assessing State specific options for leveraging federal financial participation, including provider/ MCO tax and donation programs, CPE, IGT, DSH, UPL, DSRIP and Value Based Purchasing programs.

Where We're Headed

Managed care is now considered the primary financing and delivery mechanism for health care within the United States. Using our considerable experience and expertise with managed care, Myers and Stauffer is in a unique position to assist government health care leaders ensure that MCOs deliver all agreed-upon services to the populations that rely on such critical health care services.