Posts by Julie Ottomano
Is Your Behavioral Health Network Data—Accurate?
Based on the CY24 Final Rule—the Centers for Medicare & Medicaid Services (CMS) is cracking down on Network Adequacy to improve access to Behavioral Health. In order to build strong Medicare Advantage (MA) Behavioral Health networks that improve timely access to services—CMS is finalizing policies to strengthen network adequacy requirements and reaffirm MA organizations’ responsibilities…Read More
CY24 ANOC & EOC Proposed Models—Second Round Available for Comment
A link to the latest CY24 ANOC & EOC proposed models was included in the Federal Register on Friday, April 28, 2023, for a 30-day comment period. Comments are due by May 30, 2023. Proposed CY24 models for the 60-day comment period were published in December 2022. To access the drafts, summary of edits, and…Read More
ACAP Selects CODY® as a Preferred Vendor to Support Not-for-Profit Safety Net Health Plans Nationwide
TAMPA, Fla. (April 26, 2023) – The Association for Community Affiliated Plans (ACAP) has selected CODY®, a Tampa, Fla-based healthcare technology and consulting firm, as a Preferred Vendor for Member/Provider Communications Consulting and Software, Appeals & Grievances, and CMS Audit Support. The ACAP Preferred Vendor Program provides access to pre-qualified vendors to support their current…Read More
Coming Soon – CY24 Model Materials
In May, CMS expects to release the Contract Year (CY) 2024 model materials. These will be posted on the CMS site, CMS Marketing Models, and will include: Annual Notice of Change (ANOC) Evidence of Coverage (EOC) ANOC and EOC standardized model instructions Provider Directory Also expected to be released in May are the CY24 Part…Read More
CMS Final Rule—CY 2024 Policy and Technical Changes
The Calendar Year 2024 Policy and Technical Changes (CMS Final Rule) was released by the Centers for Medicare & Medicaid Services (CMS) on April 12, 2023. The final rule includes major revisions to regulations governing Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). Some proposed…Read More
Medicare Secondary Payer (MSP) Processing—What’s Your Revenue Recovery Potential?
Medicare Secondary Payer (MSP) is generally used when another entity is responsible for paying before Medicare. The MSP regulations were put in place to protect Medicare Trust Funds by preventing Medicare funds from being used to pay for items and services that other health insurers are primarily responsible for paying. Primary payers essentially have the…Read More
A True End-to-End (E2E) Communications Suite is Essential for Health Plans—Here’s Why…
As Health Plans know well—planning, building, maintaining, and fulfilling accurate mandated member and provider materials requires alignment of all departments and months of coordinating and managing internal and external dependencies and deliverables to meet AEP timelines. Dates like September 30th and October 15th are ingrained in memory, and summers become a head-down race to deliver…Read More
CMS’s Plan Benefit Package (PBP) Software—Technical Redesign Coming to HPMS
CMS is modernizing its Plan Benefit Package (PBP) bid submission module for Contract Year (CY) 2024 Going live on April 7, 2023—the new web-based Plan Benefit Package (PBP) Software Technical Redesign will live within the Health Plan Management System (HPMS) and include updates to the user interface and data entry workflow. In previous years, users…Read More
CMS CY 2024 Advanced Notice — The Inflation Reduction Act Requirements on Member Communications
Comments are due by March 3, 2023. The final notice will be released by April 3, 2023. The Inflation Reduction Act (IRA) of 2022 provides many provisions to reduce prescription drug costs for Medicare beneficiaries and Medicare Advantage (MA) members. The CMS CY 2024 Advance Notice included updates related to the IRA that should be…Read More
How to Promote a Strong Compliance Culture—That’s Effective!
An organization’s commitment to compliance, or its compliance culture, is an important component of its overall organizational culture. Organizational culture is defined in The Cambridge Dictionary as the types of attitudes and agreed ways of working shared by the employees of a company or organization. A strong compliance culture is an organization-wide commitment to adhere…Read More