In the world of Medicare and Medicaid, choosing a consulting partner to help streamline your health plan’s operations can be tricky. While a company or individual may be well-versed in best practices for project management or operational efficiency, they may not understand the unique requirements of the payer market – making them less than effective…

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Health plans today are feeling more pressure than ever before to do more with less. With increased scrutiny from The Centers for Medicare and Medicaid Services (CMS) and decreased budgets, leadership is constantly looking for ways to save money. Doing so might be easier than you think. Below are three ways that health plans are…

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Kaiser Health News recently published an article about Senator Chuck Grassley (R-Iowa) asking federal health officials to tighten scrutiny of private Medicare Advantage (MA) health plans. His request comes amid ongoing concern that insurers over-bill the government by billions of dollars every year. In mid-April, Grassley wrote a letter to Centers for Medicare and Medicaid Services…

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With 10,000 Americans entering Medicare every day, the health plan industry continues to expand. In 2015, 55.5 million people were enrolled in Medicare. By 2020, that number is expected to increase to 64.4 million, and to balloon to 81.8 million by 2030. Yet, of the current 55.5 million Medicare beneficiaries, only a third are enrolled in…

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Good news for Medicare agents and brokers: The Centers for Medicare and Medicaid Services (CMS) recently reported that of the 1,320 marketing events secretly shopped during the 2014 contract year Annual Enrollment Period (AEP), 85.5% were fully compliant. This is a huge improvement from previous years, when CMS found more than half of secretly shopped…

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The Centers for Medicare & Medicaid Services (CMS) recently released its model documents for the 2017 Annual Enrollment Period (AEP). The rigorous, highly complex rules and regulations for member marketing materials – specifically, Annual Notice of Change (ANOCs) and Evidence of Coverage (EOCs) documents – provide significant challenges for health plans year after year. Some…

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In case you missed it, Aetna and Anthem recently signed deals to merge with health insurance giants Humana and CIGNA, respectively. These mergers have created quite a stir in the insurance market, with many experts left questioning what this will mean for the managed care and commercial market in the years to come.

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Policies and procedures are an important part of health plans’ day-to-day operations. However, if these are not documented and managed properly – including being updated each year – health plans may be subject to costly fines and corrective action plans from the state.

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By now, it is safe to assume that health plans across the nation have thoroughly read and examined CMS’ Final Medicare Advantage (MA) Rate Announcement and Call Letter for 2016. I think we all heard a collective sigh of relief with the announcement that reimbursements would increase, rather than decrease, in the coming year.

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