CMS
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 MoreCMS 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 MoreCall Center Monitoring — Star Rating Measure Tips for Success
Call Center Monitoring is one of your first Star Rating measures of the new contract year. Starting in February 2023, CMS will measure interpreter and TTY availability as a metric for the CY24 Star Ratings. Monitoring calls will be placed on your prospective enrollee call center phone lines. These calls will measure interpreter availability, TTY…
Read MoreCMS Audits – Be Prepared to Avoid These Common Findings
As the 2022 Program Audit Cycle winds up with the last of the routine audit engagement letters issued in July, we are starting to see the audit results. This year saw new audit protocols, and some plans struggled with the new universe layouts. In addition, CMS added a new observation classification – ORCAs (Observation Requiring…
Read MoreAppeals & Grievances—How to Measure & Improve Workflow Efficiency
In today’s managed care world, health plans must rely on complex, time-sensitive, heavily regulated, and repetitive processes to manage their Appeals & Grievances (A&G). No matter how well-designed your workflow is, there is always room for improvement. In fact, by taking a closer look at your A&G processes, you may be surprised at the challenges…
Read MoreCMS 2023 Final Notice & Updates for D-SNPs — What Should Plans Do Now?
In May, CMS published the 2023 Final Rule in the Federal Register. The rule includes many changes related to different areas, including marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions; however, there are a number of changes related to…
Read MoreCMS Reposts CY2023 ANOC & EOC Models
On August 1, CMS reposted the revised Contract Year (CY) 2023 Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) models due to several identified issues. CMS distributed its “Model Notice Corrections” memo the following day, highlighting many of the changes. This is the first time since 2018 that CMS has provided revised models…
Read MoreRevised CMS CY23 ANOC & EOC Models — Expected Soon!
Keep an eye out for an upcoming CMS memo regarding the reposting of the CY23 ANOC & EOC models. Per CMS, the documents revealed several issues. Rather than sending a “very detailed” and lengthy corrections memo, CMS’s memo will coincide with the reposting of the models and include a summary of changes. The revised models…
Read MoreProvider Directory Accuracy—Why is it Important?
The Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage plans to post an online provider directory that is up-to-date and accurate. Beneficiaries must be able to use the online provider directory to find contracted providers they can see to receive covered services. Inaccurate provider directories pose risks to beneficiaries. Because members rely on…
Read MoreCMS Program Audit Findings & Key Preparation Tips
CMS released the 2021 Part C and Part D Program Audit and Enforcement Report on June 7, 2022. Highlights of the report indicate the average audit scores increased over the last report, stating 2020 average overall audit score of 0.15 to 2021 average overall audit score of 0.44. It’s worth noting, there were 27 plans…
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