SMBLEDARC (Scrambled)
ENCCPLAOIM
What is COMPLIANCE?
Examples of these include: leaving associate ID visibly unattended, leaving a key in a lockable unit, having an unlocked computer screen displayed and unattended.
What are Privacy Infractions?
The Integrity team prepares this annually, which outlines their scheduled activities for the year.
What is the Auditing and Monitoring Plan?
CMS uses these memos to provide clarity to stakeholders and publish updated guidance.
What are HPMS memos?
This committee coordinates efforts to manage, measure, and improve the quality of Pharmacy Benefit Management and has oversight responsibility for PerformRx's quality improvement activities.
What is the Quality Management Committee (QMC)?
MCS
What is a CMS?
Associates must report suspected privacy incidents using this online tool.
What is NAVEX?
This assessment is conducted annually by the Integrity team to identify potential threats to the organization.
What is a Risk Assessment?
Information on Negative Formulary Changes can be found in this Chapter of the Medicare Prescription Drug Benefit Manual?
What is Chapter 6?
This is a plan for developing and improving processes, which includes a timeline, activities, and assessment measures of quality and quality improvement within the organization.
What is a Quality Improvement Plan (QIP)?
HARBEC
What is BREACH?
This is the acronym for the Federal Health Insurance Portability and Accountability Act of 1996
What is HIPAA?
This is another term for unplanned auditing and monitoring activities.
What is "ad hoc" auditing and monitoring?
According to Chapter 9 of the Part D Prescription Drug Benefit Manual, there are this many elements to an effective compliance program?
What are 7 elements?
This document establishes performance measures for services managed by PerformRx and defines goals and objectives for the quality activities scheduled for the year.
What is the Quality Work Plan?
TIDUA
What is AUDIT?
When emailing PHI outside of the organization, associates must type this in the subject header.
What is #secure?
In 2018, PerformRx procured the services of this company to conduct an independent audit of a series of non-compliance issues.
What is Optimity Advisors? (Optimity)
This annual communication is published by CMS each year and is considered to be the most important communication to govern the Part D space for the coming year.
What is the Call Letter?
PerformRx earned accreditations from these two organizations.
What are URAC and NCQA?
DRUAF
What is FRAUD?
The abbreviation "PHI" stands for this.
What is Protected Health Information?
The Integrity team reports updates quarterly to this PerformRx committee.
What is the Compliance Committee?
Information about Coverage Determinations, Grievances, and Appeals can be found in this Chapter of the Prescription Drug Benefit Manual.
What is the Chapter 18?
This is the rating system used in Medicare to measure how well Part D plans perform in several categories.
What is the Medicare Star Ratings System?