AEP 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…

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CMS 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…

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AEP 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…

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How 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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What Do CMS’s Final Rule Updates Mean for Medicare Advantage Programs?

Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Final Rule document that codifies the regulations for Medicare and Medicaid programs. After analyzing the complete 272-page Final Rule document—here are important regulatory CY22 changes worth noting: Medicare Communications and Marketing Guidelines (MCMG) document: While CMS believes it would be duplicative to produce…

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An Advance Look at Medicare Advantage Benefits Changes for CY2022

Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Plan Benefit Package (PBP) Software that Medicare Advantage (MA) and Part D plans use as part of their bid submissions. The PBP Beta Software is released in late January to allow plans to test and provide feedback before the full version is available…

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How to Mitigate Compliance Risk & Improve Operations—An A-to-Z Approach

As the Centers for Medicare and Medicaid Services (CMS) increases its scrutiny and escalates enforcement, Compliance managers are on guard to ensure regulatory standards are met—and fines, sanctions, or even termination from CMS programs, are avoided. How can Compliance and Operations managers mitigate compliance risk and improve operations? The best way to avoid compliance errors…

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Are Your Policies and Procedures Audit-Ready?

Policies and procedures are essential tools for any organization. By clearly articulating the requirements established by external oversight bodies and internal standards, they are an effective control to support consistency, accountability, and compliance. To be effective, policies and procedures should be: Designed as tools that help employees make decisions related to their assigned tasks/responsibilities; Clear,…

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CODY CEO authors chapter in new book for healthcare compliance professionals

Deb Mabari’s chapter covers payer privacy issues in the Health Care Compliance Association’s latest edition of “Health Care Privacy Compliance Handbook” TAMPA, Fla. (Oct. 27, 2020) – Deb Mabari, chief executive officer of CODY®, a Tampa, Fla.-based healthcare technology and consulting firm, has authored a chapter in the Health Care Compliance Association’s newest edition of…

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Can Artificial Intelligence (AI) Change the Future of Healthcare Operations?

Artificial Intelligence (AI) will become a larger factor in all facets of life soon… …in everything from self-driving cars to industrial manufacturing to the way we entertain ourselves. These changes will impact every part of healthcare also, from diagnosis through treatment and even into administrative and operational functions. CMS has started two initiatives directly related…

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