CODY® Insights

PERSPECTIVES: Combining Medicare and Medicaid into One Program

The status quo of government-sponsored health programs is beginning to fail. The government recently reported that Medicare will run out of money in less than 20 years unless drastic changes are made. But how can our health care system be altered to correct deficiencies and adjust to changing conditions, avoid a huge financial crisis in…

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Dealing with Change in the Medicare World

The healthcare world and Medicare health coverage are in a state of rapid and uncertain change. What can health plans and those serving health plans, such as pharmacy benefit managers and even consultants, do to be ready for both anticipated and unanticipated changes? Here are some of the issues facing the industry in today’s turbulent…

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What Sets CODY Apart from Other Consulting Firms

Health plans have many options when searching for a consulting partner to help streamline operations and/or outsource key business functions – and not all of them are created equally. There are certain traits to look for when hiring a great consulting partner and many will check most or all of these boxes. So, what sets…

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CODY experiences double-digit growth, adds four to growing team

TAMPA, Fla. (June 25, 2018) — Responding to a recent uptick in health plan clients and the growing need for health plan consulting services, Tampa-based CODY has hired four new team members, including Hannah LaMere as Director, Special Projects and three new consultants. These new hires will grow the company’s consulting department and help clients…

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What Does CMS’s New Rule Regarding Electronic EOCs Mean for Health Plans?

In its 2019 annual notice, The Centers for Medicare & Medicaid Services (CMS) issued regulatory changes that impact how and when health plans must provide Evidence of Coverage (EOC) documents to members. What the Rule Allows The rule brings the following major changes to Medicare Advantage Organizations (MAOs), Medicare Prescription Drug Plans (PDPs), and section…

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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…

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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…

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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…

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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…

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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…

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