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Provider 360 Program

Overview

Continuous Improvement is best thought of as a business culture or approach which involves everyone – leadership, management and employees – in finding and eliminating waste on an ongoing basis. CGS's Provider 360 (P360) program assists providers and suppliers in reducing/eliminating claim denials and errors by way of Lean education. Lean is a systematic approach to reduce or eliminate activities that do not add value to the process. There is no cost to participate in the program which has two pathway options; Lean Education and Personalized Lean Education.

Please review the following program details to determine which Lean Education Option is right for your organization.

Option 1: Provider 360 (P360) Lean Education

This option includes one informative webinar. The webinar will cover Lean Process Improvement Tools (i.e., Root Cause Analysis, Quality Assurance Standards) that will help your organization identify issues that may cause claim denials and errors.

One Webinar (1.5 Hours)

One Webinar (1.5 Hours)

During this informative webinar your organization will learn the basics of Lean, including valuable Lean Process Improvement Tools. After viewing the webinar, your organization will be equipped with the knowledge necessary to build a Value Stream Process Map and identify Opportunities for Improvement (OFIs) through Root Cause Analysis (RCA).

Review the CGS P360 Information GuidePDF for more information about Lean. If you would like to view the informative P360 Lean Education webinar, click hereWindows Media Video.


Option 2: Provider 360 (P360) Personalized Lean Education

This option includes three informative sessions. Session 1 covers Lean Process Improvement tools (i.e., Root Cause Analysis, Quality Assurance Standards) that will help your organization identify issues that may cause claim denials and errors. After attending the session, your organization will be equipped with the knowledge necessary to build a Value Stream Process Map and identify Opportunities for Improvement (OFIs) through Root Cause Analysis (RCA). The difference in Session 1 and the webinar in Option 1 is that this session is personalized and is led by a CGS Continuous Improvement Coach.

During Session 2 we will review your specific claim errors and/or denials and Session 3 is the final Follow Up Session where we will review together your Opportunities for Improvement (OFIs) from your Value Stream Process Map.

Three Sessions (4.5 Hours) 

Three Sessions (4.5 Hours)

To view the details for each session, click on the title hyperlink below. If you are interested in the Personalized Education option, please first review the CGS P360 Personalized Lean Education FAQPDF, and watch the CGS P360 Introduction Video. Once you have reviewed the FAQ and watched the video and understand the commitment, please click here if you would like to submit a request to participate.

Lean Education: Session 1 (1.5 hrs.)

Personalized Education: Session 2 (1.5 hrs.)

Follow Up: Session 3 (1.5 hrs.)


Supplier Comments

Provider Comments

"I truly encourage all providers even those that have not had and reviews or audits to use this resource"

"The open dialogue was refreshing. I did not expect to be able to toss ideas around and be able to have open discussions outside of stating the rules and requirements"

"Everyone at CGS was terrific and very helpful with the learning tools that were given to us as well as their feedback to help us understand better"


P360 Resources

P360 Resources


CGS P360 Information GuidePDF

CGS P360 Personalized Lean Education FAQPDF

CGS P360 Introduction Video

Three Sessions (4.5 Hours) 

General Education


CMS Comprehensive Error Rate Testing (CERT)External website

CMS CERT ReportsExternal website

CMS CERT C3HUBExternal website

CERT Task Force

CMS Medicare Coverage Determination ProcessExternal website

Local Coverage Determinations (LCDs)

CMS Internet Only Manuals (IOMs)External website

Medical Review Resources

Additional Documentation Request (ADR) Process

Provider Outreach and Education Resources

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