Medicare

Highlights of Medicare Advantage Chapter 2 (Enroll & Disenroll) Updates Updates for Chapter 2 of the Medicare Managed Care Manual have been posted to the CMS website–and be aware that the amount of changes are more than we typically see. Plans must be responsive and alert to these updates to ensure enrollment and operations processes…

From the Desk of … Readiness Checklist – Annual Task to Complete or a Valuable Profitability Tool? CMS provides a comprehensive Readiness Checklist in October to be used as a self-assessment of your health plan’s ability to meet CMS requirements for the upcoming plan year. The Readiness Checklist includes many of the same critical requirements…

What Is an Independent Certification for Enrollment and Premium Billing? An Independent Certification is conducted by a third party (such as Madena), who performs an independent analysis of the accuracy of your health plan’s enrollment, premium billing, and reconciliation processes. Using our Membership Suite™TM software, we can load a simple membership and invoice extract to…

What to Do With Your COB Full File On 4/14/2020, CMS announced the annual full replacement files were delivered to clients between 4/27/2020 and 4/30/2020. This memo generally provides confusion to clients, and understandably so! The most common question that I receive is: Do I have to send out the annual survey when we receive…

Weathering the Pandemic: Solutions for Staff Shortages We acknowledge that the COVID-19 pandemic is occupying everyone’s attention and time. We hope you are well and safe. We recognize that life is radically different for most of us—both personally and at work—than it was just a few weeks ago. Our company has made changes as needed…

Provider Directory and Data Accuracy Because members rely on provider directories to locate an in-network provider, inaccuracies could pose a significant access-to-care barrier. As a result, CMS can, and does, issue compliance actions as a result of directory inaccuracies. Earlier this year CMS announced the use of the National Plan and Provider Enumeration System (NPPES)…

Highlights of Proposed 2020 Audit Protocols CMS started proposing changes to the 2020 Program Audit protocols in August 2019. The revised protocols are now being finalized by CMS. Sponsoring organizations should expect routine program audit engagement letters from March through July 2020. In general, CMS simplified and provided greater clarity in the five protocols by…

AEP Is Over – Now What? Whether you are a new or existing Medicare plan, January is the best time to make sure your membership is accurate, digest any issues identified, and develop a process improvement plan. Successful enrollment processing requires training, execution of established processes, and an ability to adjust as needed based on…