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.

1. Create a Comprehensive Task List and Timeline

Numerous tasks and various departments and people are involved in creating AEP materials from start to finish. Having a well-thought-out production timeline will help ensure your materials are completed on time and are compliant. Consider using a program, such as CodySoft, that allows you to assign tasks, people and deadlines to ensure streamlined project management, as this can make the job infinitely easier.

2. Use the 2015 Model Documents

Some health plans may be tempted to create their 2015 AEP materials by making updates to their 2014 templates. However, if one data point of the thousands you update is missed, your health plan is out of compliance. Using the 2015 model documents provided by CMS – which only requires a 10-day file and use approval period – is the least risky and most expeditious way to prepare your AEP materials.

3. Use a “Central Source of Truth” Data Grid for All Plan Benefit Information

Plan benefit information that must be included in members’ ANOCs, EOCs and Summary of Benefits (SB) could have variables that number in the tens of thousands. With such a large number of data elements to manage, plans must use one “central source of truth” for benefit information if they expect to meet CMS’s requirements. A tool like CodySoft will help automate this process and ensure CMS compliance.

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.

Based on Medicare compliance programs, Medicaid plans can expect CMS to require increased operational reporting and increased compliance within the risk management function. To best prepare for rigorous compliance changes, Medicaid plans should:

Streamline process workflow

Conformity with CMS compliance guidance requires highly efficient communication and effective collaboration between a number of operative departments throughout a health plan. Marketing communications, compliance, IT, operations and medical management will need to coordinate their functional activities and reporting in order to comply with CMS standards. An effective process workflow that keeps everything running smoothly, on-time and in compliance is critical.

Enhance project management

Health plan member communications directors have the tough job of guiding collateral through a creation cycle that includes tracking multiple versions, pushing through numerous bottlenecks, dealing with multiple subject matter experts, ensuring regulatory compliance and setting up printing and delivery. An effective project management tool specifically designed for health plans can make things infinitely simpler and ensure materials are in compliance with CMS. This will also enable easier reporting when CMS audits are required.

Improve risk management

A robust risk management function will be essential for Medicaid plans required to detect, mitigate and alleviate risk throughout an organization. An organization’s risk management tool is key to compliance management as federal and state guidance evolves at a brisk pace.

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:

Be strategic in how you handle the change order process.

Change orders can get very expensive, and unfortunately, they are going to happen. In Part 1, we covered tips on how to mitigate some potential errors, such as getting your materials in the best possible order before they go to the printer. But unexpected things are going to happen – you must plan and prepare for change orders.

Most importantly, always budget for change orders. Pull print and fulfillment orders from the past couple years and calculate the average amount you spent on change orders. Then include that amount in the budget for your next job.

Compare the vendor’s track record to the Service Level Agreement.

Presuming you followed the suggestion in Part 1 to set a Service Level Agreement that ensures the vendor has the flexibility to accommodate unpredictable timelines, regularly review the SLA to ensure the vendor is meeting your deadlines.

A vendor’s ability to meet its Service Level Agreement is a direct indication of its performance. Was the vendor able to meet your deadlines despite only having two days to complete your last print job, as outlined in the SLA? If not, the vendor may not be the best fit for your needs.

Hold Quarterly Business Reviews and challenge the vendor to add value.

Once a quarter, meet with your print and fulfillment vendor to debrief and discuss potential areas of savings. Talk about what went well and what didn’t go well during the past quarter, and what should be done differently in the future.

Don’t be afraid to ask your vendor how they can add more value. For example, pose the following question and see what kind of answer you get: “If I told you we need to reduce our spend by 10 percent, what would you do to make that happen?”

If the vendor is truly your partner, they will continually look for and suggest solutions to achieve better integration of workflows, which will translate into savings for your health plan.

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:

Get your process workflow in order.

If your health plan is providing its print and fulfillment vendor files that have errors, do not have all necessary approvals or are not in compliance with CMS, you have problems right out of the gate. Errors in data grids and crosswalks alone lead to costly reprints.

Make sure your marketing communications and compliance departments have the right tools to streamline workflow, track materials and ensure compliance. That way, your materials are in the best possible order before they go to the printer. This also helps set a good example for the vendor and implies you have high expectations for them, as well.

Understand the vendor’s true capabilities.

Select a vendor that matches your level of success. The larger the health plan, the greater the complexity of its printing needs – especially for government-sponsored plans with the additional risk that the Annual Notification of Change (ANOC) bring.

If you hired a local vendor when your health plan had 15,000 members and it now has 50,000 members, seriously consider investigating whether that vendor is still the best fit. A smaller vendor simply may not be able to handle the numerous checks and balances required to meet CMS regulations.

In the RFI, ask questions specifically about Medicare and Medicaid.

In your Request for Information, ask the vendor questions that allow you to confirm they understand and have the ability to handle the complexities of CMS, such as: “Can you give an example of how you have handled the ANOCs in the past, including how you addressed challenges with deadlines for these document?”

Consider hiring an unbiased, independent consultant to do the RFI for you, and ask them to use a weighted scale based on importance to find the vendor that best meets your needs.

Do a site visit before hiring the vendor.

Visit the vendor’s facility before making any hiring decisions. Observe their output and Q&A process, which is spot-checking materials for quality as they come off the press. Also, make sure the equipment can handle the size of print runs you know your health plan will require during the busy time of year. Failure to do this could result in missed sales opportunities due to materials not being available.

Ensure the vendor is flexible enough to handle delays caused by CMS.

A Service Level Agreement (SLA) is a timeline of all tasks associated with a print job. It’s especially important for government-sponsored health plans to make sure the vendor is flexible enough to handle delays and complications presented by CMS that will impact production timelines.

Your vendor must understand that they may have either 10 days or two days to produce materials, and they must be able to manage their workflow to accommodate expedited jobs. Make sure the vendor’s SLA is flexible enough to meet your deadlines.