CODY® Insights

3 Keys to a Successful Compliance Program

Complying with state and federal rules and regulations is a challenging endeavor. It requires health plans to manage a slew of different processes and resources.  Missteps pose risks that could result in compliance violations, fines and a drop on CMS’s Five Star Quality Ratings. Some of the most difficult areas to manage, from a compliance…

Read More

Can Outsourcing Your Member Marketing Materials Production Pay for Itself?

Many health plans are currently considering how to manage creation and distribution of marketing materials due to members September 30. The reality is, health plans have two options: Develop materials in-house, and outsource printing and fulfillment to a vendor; or Outsource the entire materials production process – materials creation, and print and fulfillment – to…

Read More

Are you Outsourcing your ANOC and EOC Creation to the Best People for the Job?

Preparing materials for the Annual Enrollment Period (AEP) – namely Annual Notice of Changes (ANOC), Evidence of Coverage (EOC), and Summary of Benefits (SB) documents – can be a time-consuming, labor-intensive process wrought with compliance risk. As a result, many health plans opt to outsource the creation of these documents to a third-party vendor. There…

Read More

How to Avoid FDR Oversight Issues in a CMS CPE Audit

First Tier, Downstream or Related Entity (FDR) Oversight continues to be a hot topic for the Centers for Medicare and Medicaid Services (CMS) and plan sponsors. CMS auditors annually find deficiencies in FDR oversight and monitoring activities in program audits, with poor oversight of FDRs trending as a common condition in yearly audits. Many plan…

Read More

6 Traits of a Great Consulting Partner

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…

Read More

What Health Plans can Expect in 2018

With a new year right around the corner, we asked our team of experts: What can health plans expect in 2018? Listed below are a few issues health plans should be aware of and keep an eye on as we move into the new year. These cover the areas of compliance, technology, and member marketing…

Read More

3 Ways your Health Plan is Overspending – And How to Stop

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…

Read More

Start Now for an Easier ANOCs and EOCs Creation Season Next Year

Every year, the people who produce marketing materials for their Medicare members are extremely busy from April through September. Deadlines are tight and timelines are aggressive for creating, printing and mailing the Annual Notice of Changes (ANOCs), Evidence of Coverage (EOCs) and Summary of Benefits (SBs) documents. Very few people in these roles take vacation…

Read More

Errors in ANOCs and EOCs could cost up to $55 per affected enrollee

Over the last several years, The Centers for Medicare and Medicaid Services (CMS) has taken an increasingly tough stance on health plans that distribute Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents with unclear and/or inaccurate benefit information. CMS is no longer sending health plans warnings for these errors; they are imposing…

Read More