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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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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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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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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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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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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Health plans are wondering “where are my updated Medicare Communications and Marketing Guidelines (MCMG)?” For the second consecutive year, the Centers for Medicare & Medicaid Services (CMS) stated that there will be no updated MCMG for CY2021. Instead, plans are instructed to use the existing MCMG and related memos from CY2020. How will changes be…

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The new CodySoft Module is part of an enterprise-wide solution to help health plans manage critical aspects of CMS compliance and reporting. TAMPA, Fla. (May 5, 2020) – CODY®, a Tampa, Fla.-based technology provider and consulting firm, has announced a new addition to its CodySoft® toolkit for health plans. The Appeals and Grievances Module® is…

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Dude, where’s my flying car Electronic Medical Record/Electronic Health Record (EMR/EHR)? The year is 1989, and the panel discussion focuses on electronic medical records. One panelist expresses concern about the vulnerability of such a system: imagine if someone walked by with a high-powered magnet. A more forward-thinking panelist remarks that the same thing would happen…

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CPE Audit Tracer Presentations continue to be a hot button for plan sponsors.  CMS auditors frequently find compliance and operational deficiencies through the tracer process. Since the Compliance Officer is responsible for the management of tracer presentations, it is crucial that the Compliance Program employs strict protocols for the development of the tracer presentations and…

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