For MA Plans: Increased Payments will mean Increased Compliance

By now, it is safe to assume that health plans across the nation have thoroughly read and examined CMS’ Final Medicare Advantage (MA) Rate Announcement and Call Letter for 2016. I think we all heard a collective sigh of relief with the announcement that reimbursements would increase, rather than decrease, in the coming year.

However, while this is great news for MA plans, it will likely come with strings attached.

With increased payments, plans should expect increased regulatory oversight, as CMS will be on a sharper lookout for compliance violations – and not just in those areas outlined in the call letter, such as maintaining real-time updates for formularies and provider directories.

So what does that mean for health plans that need to prepare for this increased oversight?

It’s very important, especially now, that member materials like pre-enrollment kits, annual notification of change (ANOC), evidence of coverage (EOC), summary of benefits and post-enrollment kits are accurate, trackable and traceable.

Multiple erratas and extensive complaints in these areas will cause CMS to take notice and could potentially put a plan under the microscope. This may result in CMS looking through all areas of a health plan’s operation because ANOCs and EOCs were not compliant.

To better manage this process and reduce the risk of non-compliance, health plans should identify the appropriate resources to help them manage creation and distribution of these materials.

It’s one of the reasons we developed the CodySoft® Collateral Management Module®, which helps manage all aspects of development, tracking and distribution of ANOCs and EOCs. When integrated with our other CodySoft modules, it can also manage scheduling, compliance, document creation, as well as overall project management.