Beginning in 2016, all Qualified Health Plan (QHP) issuers operating in healthcare exchanges will be required to submit strict quality data on a number of measures under the Center for Medicare and Medicaid’s (CMS’) Quality Ratings System (QRS).
Lessons Learned from the 2015 AEP Materials Creation Season – And how to best prepare for next year
At the end of September, Medicare Advantage (MA) and Prescription Drug Plans (PDPs) should have successfully delivered to members their Annual Notification of Changes (ANOC) and Evidence of Coverage (EOC) materials. This should come as a relief to health plans, as creating these materials – which must be distributed before the Annual Enrollment Period (AEP) – can be a time-consuming, labor-intensive process wrought with compliance risk.
Cody Experts Share Insights on Increased Government Oversight in MHPA Webinar
In September, Cody Consulting hosted the webinar “Increasing Federal Government Oversight…And How Medicaid Plans Can Prepare” as part of the Medicaid Health Plans of America (MHPA) Wednesday Webinar series. The presentation, which can now be viewed on the MPHA website, shared with attendees an overview of the type and level of oversight that the states and Medicaid plans can expect, as well as ways to prepare for these changes.
Surviving the 2015 AEP Materials Creation Process – Part 2 of 2
Medicare plans are mid-way through the process of creating Annual Election Period (AEP) materials – namely, Annual Notification of Change (ANOC) and Evidence of Coverage (EOC) documents – that are due to members by the end of September.
At this stage of the game, tension is running high. By now, many health plans have likely discovered the way they were planning on creating the documents won’t work, have encountered issues with vendors, or any other number of challenges that put tasks and timelines into a tailspin.
Surviving the 2015 AEP Materials Creation Process – Part 1 of 2
The Centers for Medicare & Medicaid Services (CMS) recently released its model documents for the 2015 Annual Enrollment Period (AEP). The rigorous, highly complex rules and regulations for member marketing materials wreak havoc on health plans year after year – and the clock is now ticking.
Medicare plans must create, print and deliver AEP materials, specifically, Annual Notification of Change (ANOCs) and Evidence of Coverage (EOCs), to members by September 30. Preparing AEP materials can be a time-consuming, labor-intensive process and wrought with compliance risk.
How the ACA Will Create a More Portable Workforce
Health insurance, pensions, retirement plans and other employer-sponsored benefits were originally created during World War II as a way for companies to be more competitive in attracting and retaining employees. Countless factors over the decades have changed the shape of company benefits, but the Affordable Care Act (ACA) is going to dramatically change the dynamic between employers and employees in the immediate future. Employees will no longer rely on employers for health insurance coverage, and what that will translate to is a more “portable” American workforce.
How Medicaid Plans can Prepare Compliance Efforts for Increased CMS Oversight
The writing is on the wall. There are well-documented issues of a lack of uniformity and accountability surrounding state Medicaid programs. Understanding CMS’s history of recognizing problems and acting to find solutions, it stands to reason the agency will, in the future, establish compliance programs for state Medicaid plans that mirror those of Medicare.
When CMS establishes greater control and oversight of Medicaid at the state level, government-sponsored health plans will have a new set of issues to work through in order to comply with the new regulatory guidance. The good news is these new regulations will most certainly mirror those already in effect for Medicare. Therefore, mirroring best practices in Medicare compliance today will better position health plans in the future.
The Millions of Dollars in Savings You’re Not Seeing – PART 2 of 2
The “cost to do business” doesn’t have to be so expensive for government-sponsored health plans. Most payers are overspending on their annual print and fulfillment budget for member communications by 10-15 percent. For plans with 250,000 members, for example, cutting a 15 percent overspend factors to saving $1.2 million a year.
There are a number of ways health plans can cut unnecessary expenses, both before hiring a print and fulfillment vendor and during the course of the relationship. The key is knowing where to look.
This blog entry, Part 2 of 2, shares what you can do while you’re working with a print and fulfillment vendor:
Read more »
The Millions of Dollars in Savings You’re Not Seeing – PART 1 of 2
The “cost to do business” doesn’t have to be so expensive for government-sponsored health plans. Most payers are overspending on their annual print and fulfillment budget for member communications by 10-15 percent. For plans with 250,000 members, for example, cutting a 15 percent overspend factors to saving $1.2 million a year.
There are a number of ways health plans can cut unnecessary expenses, both before hiring a print and fulfillment vendor and during the course of the relationship. The key is knowing where to look.
This blog entry, Part 1 of 2, shares what you can do before you contract a print and fulfillment vendor:
