Call Center Monitoring — Star Rating Measure Tips for Success

Call Center Monitoring is one of your first Star Rating measures of the new contract year. Starting in February 2023, CMS will measure interpreter and TTY availability as a metric for the CY24 Star Ratings. Monitoring calls will be placed on your prospective enrollee call center phone lines. These calls will measure interpreter availability, TTY…

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CMS Audits – Be Prepared to Avoid These Common Findings

As the 2022 Program Audit Cycle winds up with the last of the routine audit engagement letters issued in July, we are starting to see the audit results. This year saw new audit protocols, and some plans struggled with the new universe layouts. In addition, CMS added a new observation classification – ORCAs (Observation Requiring…

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CY 2023 CMS Readiness Checklist – Why is this Exercise Important?

Every October, the Centers for Medicare & Medicaid Services (CMS) distributes a Readiness Checklist to Medicare Advantage and Prescription Drug Plan (MAPD) Sponsors as a reminder to prepare for the upcoming plan year. Although CMS no longer requires Sponsors to submit assessment attestations, CMS still expects Sponsors to review the comprehensive checklist and self-assess their…

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End-of-Year 2022 Enrollment and Payment Systems Processing—What You Need to Know

As the CMS Annual Rollover process quickly approaches, health plans must prepare to complete critical End-of-Year (EOY) tasks. Now’s the time to ask—Are your systems configured to process rollover files seamlessly? Does your staff know how to process transactions requiring manual intervention? Any mishaps during this process will create a negative member experience regarding access…

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Appeals & Grievances—How to Measure & Improve Workflow Efficiency

In today’s managed care world, health plans must rely on complex, time-sensitive, heavily regulated, and repetitive processes to manage their Appeals & Grievances (A&G). No matter how well-designed your workflow is, there is always room for improvement. In fact, by taking a closer look at your A&G processes, you may be surprised at the challenges…

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AEP 2023—Essential Readiness Tips & the Latest CMS Guidance

Medicare Advantage Annual Enrollment Period (AEP) runs from October 15 to December 7. Since most health plans recognize growth this time of year, it is imperative to be prepared to enroll members seamlessly and accurately. Are your systems configured with the latest guidance from CMS? Has your staffing and training efforts increased to ensure work…

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CMS 2023 Final Notice & Updates for D-SNPs — What Should Plans Do Now?

In May, CMS published the 2023 Final Rule in the Federal Register. The rule includes many changes related to different areas, including marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions; however, there are a number of changes related to…

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CMS Reposts CY2023 ANOC & EOC Models

On August 1, CMS reposted the revised Contract Year (CY) 2023 Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) models due to several identified issues. CMS distributed its “Model Notice Corrections” memo the following day, highlighting many of the changes. This is the first time since 2018 that CMS has provided revised models…

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Revised CMS CY23 ANOC & EOC Models — Expected Soon!

Keep an eye out for an upcoming CMS memo regarding the reposting of the CY23 ANOC & EOC models. Per CMS, the documents revealed several issues. Rather than sending a “very detailed” and lengthy corrections memo, CMS’s memo will coincide with the reposting of the models and include a summary of changes. The revised models…

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