Compliance
The Pros and Cons of Updating Last Year’s AEP Materials vs. Using CMS’s Model Docs
The Centers for Medicare & Medicaid Services (CMS) will release its 2018 Model Documents for Annual Enrollment Period (AEP) materials any day. When it does, health plans will face the same question they face year after year – do we start fresh using this year’s Model Documents or update last year’s materials? With Annual Notice…
Read MoreBest Practices for Language beyond the CMS Model Language
The Centers for Medicare and Medicaid Services (CMS) templates for the Annual Notice of Changes (ANOC) and Evidence of Coverage (EOC) contain extensive model language that is required and must be used by every insurer. However, there are also numerous places in these documents where health plans have latitude and flexibility to use their own…
Read MoreIndustry Alert: Is Your Health Plan the Target of CMS’s New Audit Focus?
Vikki Ahern, CMS Director for Medicare Part C/D Oversight and Enforcement Group (MOEG), spoke at this week’s 2017 HCCA Managed Care Compliance Conference. It served as a wake-up call for compliance professionals in attendance. Although an explanation of CMS’s reasoning was not provided, Vicki Ahern stated that CMS will specifically target small parent plans for…
Read MoreHow Accurate ANOCs and EOCs can Help Health Plans Retain Members
The Henry J. Kaiser Family Foundation recently published an Issue Brief on its website titled “Medicare Advantage Plan Switching: Exception or Norm?” The brief shared that 11 percent of Medicare Advantage plan enrollees in 2013 voluntarily switched to another plan in 2014. It also addressed various factors that impacted switches to other plans, such as…
Read More4 Ways to Prepare for Increased CMS Oversight in the wake of Secret Shopper Success
Good news for Medicare agents and brokers: The Centers for Medicare and Medicaid Services (CMS) recently reported that of the 1,320 marketing events secretly shopped during the 2014 contract year Annual Enrollment Period (AEP), 85.5% were fully compliant. This is a huge improvement from previous years, when CMS found more than half of secretly shopped…
Read MoreAre you prepared for a CMS audit?
If The Centers for Medicare and Medicaid Services (CMS) walked through your door today and asked to audit your health plan, would you be prepared? Unfortunately, for many Medicare Advantage and prescription drug plans, the answer is “no.” Yet, with CMS continuing to crack down on compliance violations, this hypothetical audit could very well become…
Read MoreAre you Prepared for an Audit of your HPMS Memos?
If the Centers for Medicare and Medicaid Services (CMS) reviewed your procedures around Health Plan Management System (HPMS) memos tomorrow – would you be happy with the outcome? Unfortunately for many health plans, the answer is, “No.” With anywhere from 10 to 20 HPMS memos distributed each week, there’s a heavy burden on compliance departments…
Read MoreTop Reasons to Use the 2017 Model Documents to Create AEP Materials
The Centers for Medicare & Medicaid Services (CMS) recently released its model documents for the 2017 Annual Enrollment Period (AEP). The rigorous, highly complex rules and regulations for member marketing materials – specifically, Annual Notice of Change (ANOCs) and Evidence of Coverage (EOCs) documents – provide significant challenges for health plans year after year. Some…
Read MoreAre You Prepared to Comply with the Summary of Benefits Guidance Released by CMS?
On April 15, the Centers for Medicare and Medicaid Services (CMS) released the Summary of Benefit (SB) Guidance for Contract Year 2017. Based on these requirements, health plans can now more easily utilize a template to create SB versions. This is great news for health plans, because they will no longer be required to use…
Read MoreHow CodySoft® Will Address CMS’ Updates to Summary of Benefits and Coverage Template
On February 25, 2016, The Centers for Medicare and Medicaid Services (CMS) released a proposed revision to the way health plans create their Summary of Benefits (SB) documents. Within the notice, it stated that HPMS will no longer generate the SB, and that plans would develop their own SB based upon their bid data within…
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