SERVICES
Combs-Dyer Consulting specializes in:​
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)
Assisting organizations who wish to develop a FHIR roadmap
Providing subject matter expertise to payers who want to protect their programs from fraud and abuse
Explaining how the Original Medicare program protects against fraud and abuse
Assisting in the development of unsolicited proposals, grant applications, or RFP responses involving FHIR, and/or mechanism to fight potential fraud and improper payments such as prior authorization or Advanced Technology for Medical Review.
CLIENTS
Combs-Dyer Consulting's clients have included:​
Health IT Vendors
Law Firms
Provider Associations
Payers
Beneficiary Advocacy Organizations
Patient-Facing app vendors
Large, Small or Tribal Businesses That Provide Services to Federal, State, Local, or Tribal Governments
ABOUT
Melanie Combs-Dyer
Founder of COMBS-DYER CONSULTING
"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.
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.
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:
- Coverage Requirements Discovery (CRD) IG;
- Documentation Templates and Rules (DTR) IG;
- Prior Authorization Support (PAS) IG."
In my final year at CMS (2019), I advised on the language that should be included in the Interoperability and Prior Authorization NPRM."
TESTIMONIALS
