SERVICES
COMBS-DYER CONSULTING specializes in:
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explaining how the Medicare Fee-For-Service program has implemented the the FHIR standards described in the Center for Medicare & Medicaid Services (CMS) final rule on Interoperability and Prior Authorization (CMS-0057) (Melanie Combs-Dyer has 30 years of experience at the Centers for Medicare & Medicaid Services, ending in the Senior Executive Service)
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assisting organization who wish to develop a FHIR roadmap
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acting as a "sherpa" to guide organizations through the process of connecting to Original Medicare's FHIR Server for Coverage Requirements Discovery, Documentation Templates and Rules and Prior Authorization Submission
COMBS-DYER CONSULTING can also:
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provide subject matter expertise to payers who want to protect their programs from fraud and abuse,
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explain how the Original Medicare program protects against fraud and abuse
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assist in the development of unsolicited proposals, grant applications, or RFP responses involving FHIR, prior authorization or Advanced Technology for reviewing medical records.
PROJECTS
COMBS-DYER CONSULTING's projects include:
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FHIR projects, such as
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assisting organizations who want to join a QHIN FHIR Pilot for prior authorization
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using FHIR to promote Advanced Technology for applying health care coverage rules to medical records associated with claim or prior authorization request
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compliance projects, such as:
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connecting providers to tools and services that can help them remain in compliance with HHS' privacy rules
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CLIENTS
COMBS-DYER CONSULTING's
current clients include:
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health IT vendors,
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law firms,
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provider associations,
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small businesses seeking a federal, state, or local government contract related to:
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FHIR,
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non-fax methods of ordering health/social services,
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prior authorization or
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managing documents containing Protected Health Information
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COMBS-DYER CONSULTING
could also assist:
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payers,
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beneficiary advocacy organizations
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patient-facing app vendors
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large, small or tribal businesses seeking a federal, state, local, or tribal government contract related to:
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FHIR,
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non-fax methods of ordering health/social services,
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prior authorization or
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managing documents containing Protected Health Information
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ABOUT
Melanie Combs-Dyer
Prior Experience
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"During my 30 years of service at the Centers for Medicare & Medicaid Services, I gained valuable knowledge relating to the Original Medicare program and the Centers for Medicare & Mediciad Services (CMS) Interoperability regulations.
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My work at CMS focused on protecting the Medicare Trust Fund by finding, stopping and preventing fraud and abuse in the Original Medicare program. I started as a “Program Analyst” in the Bureau of Program Operations. I ended as a member of the Senior Executive Service as the Director of the Provider Compliance Group in the Center for Program Integrity. This is the group that operates the Prior Authorization programs in Original Medicare.
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In 2018, I became CMS’ representative to the Da Vinci Steering Committee — a group that formed within the HL7 organization to promote the use of Fast Healthcare Interoperability Resources (FHIR). The Da Vinci Project develops FHIR Use Cases and produces FHIR Implementation Guides (IG). Most of my time was spent on the “burden reduction” use cases which produced the:
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Coverage Requirements Discovery (CRD) IG;
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Documentation Templates and Rules (DTR) IG;
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Prior Authorization Support (PAS) IG."
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In my final year at CMS (2019), I advised on the language that should be included in the Interoperability and Prior Authorization NPRM.
Present Job
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"I advise health IT vendors, provider associations, patient advocacy organizations, payers, and others who need a subject matter expert on FHIR-enabling their current systems or building new systems.
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My passions include brainstorming about FHIR solutions that will promote better information flow between from:​
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Ordering Provider Rendering/Supplying Provider
Provider Consumer
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Provider Government Agency
Medical Provider Social Service Provider
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Provider Consumer Provider
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