Why Consolidating COB & MSP Data Collections Are Crucial for Health Plan Revenue Recovery & Compliance
The Centers for Medicare and Medicaid Services (CMS) requires MA and PDP health plans to update systems timely and accurately. Consolidating and analyzing COB & MSP data collections while maximizing recovery options and complying with CMS regulations is a challenging task. Incorrect data sets can easily contribute to non-compliance and lead to inaccurate claims payments,…
Read MoreMedicare Communications & Marketing Guidelines (MCMG)—CMS Updates Warrant a Thorough Review
Last month, CMS published a new MCMG, and it looks quite different! Not only is it much shorter, 51 pages compared to the previous 84 pages, it now has CFR references for all sections. Upon review, CMS has removed several details, seemingly anything without a CFR reference which accounts for the slimmed-down version, and it…
Read More2023 Star Rating Changes—CMS Advanced Notice for Review & Comment
CMS released the “Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies” on February 2, 2022, with feedback accepted until March 4, 2022. Some changes may impact Star Ratings for CY 2023. To submit comments or questions electronically, go to…
Read MoreAre You Prepared for Your Next CMS Program Audit?
Preparation is critical to produce accurate universes and achieve successful CMS Program Audit results. In November 2021, CMS announced they will send program audit engagement letters to sponsors, starting in February through July 2022. If you ask yourself when should your readiness for a program audit begin? The answer is NOW! CMS made several significant…
Read MoreHow to Produce AEP Documents & Manage Plan Benefits with Compressed Timelines
The second post in our AEP Best Practices series focuses on the critical path of the Annual Enrollment Period—how to produce AEP documents efficiently & manage plan benefits effectively with compressed timelines. It’s important to understand the risks and challenges with compressed timelines for health plans with several Plan Benefit Packages (PBPs). Here’s a graphic…
Read MoreAEP Enrollment Processing Tips—Do’s & Don’ts from End-to-End (E2E)
How well your organization handles a new enrollment during the Annual Enrollment Period (AEP) generally sets the tone for the upcoming contract year for you and your new member. Beginning with Sales and flowing to Enrollment Operations—it’s critical to understand specific actions that trigger reconciliation challenges and member abrasion. With CMS shifting the weight of…
Read MoreCMS Audit Updates—Proactive Steps to Ensure Readiness & Maintain Compliance
Success in any CMS audit depends on being prepared to ensure readiness and maintain compliance throughout the year. Taking proactive steps now to support future CMS audits will produce better results and experiences for health plans and create a greater level of confidence for participants. New Audit Protocols for CY2022 Earlier this year, CMS released…
Read MoreAEP Best Practices – How to Produce Compliant & Effective Member Communications
Planning for AEP (Annual Enrollment Period) As health plans prepare for AEP (Annual Enrollment Period), they face a multitude of challenges—ranging from compliance issues to mitigating risk related to timing, data, and documents. To help navigate these challenges, here are some key strategies and Best Practices for Compliant and Effective Member Communications we recently shared…
Read MoreCodySoft® Allied Central Dashboard™ (ACD) FAQs
Creating, managing, and tracking recurring orders for mandated member materials fulfillment can be complex and time-consuming. Not to mention, file and data validation, SLA management, and tracking errors, issues, and processing audits—adds even more to manage. To ease the burden, that’s where the CodySoft® Allied Central Dashboard™ (ACD) comes in. By leveraging automation, the ACD…
Read MoreHow to Build an Effective Compliance Monitoring Program & Support Ongoing Risk
A monitoring program is an important part of a health plan’s compliance program and provides valuable information to the Compliance Department to ensure the plan is meeting requirements. Effective monitoring requires coordination with operational areas and supports ongoing risk assessment. Monitoring not only provides a mechanism to detect compliance issues throughout the organization but also…
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