Posts Tagged ‘Centers for Medicare & Medicaid Services’
Is Your Behavioral Health Network Data—Accurate?
Based on the CY24 Final Rule—the Centers for Medicare & Medicaid Services (CMS) is cracking down on Network Adequacy to improve access to Behavioral Health. In order to build strong Medicare Advantage (MA) Behavioral Health networks that improve timely access to services—CMS is finalizing policies to strengthen network adequacy requirements and reaffirm MA organizations’ responsibilities…Read More
CMS Final Rule—CY 2024 Policy and Technical Changes
The Calendar Year 2024 Policy and Technical Changes (CMS Final Rule) was released by the Centers for Medicare & Medicaid Services (CMS) on April 12, 2023. The final rule includes major revisions to regulations governing Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). Some proposed…Read More
Medicare Secondary Payer (MSP) Processing—What’s Your Revenue Recovery Potential?
Medicare Secondary Payer (MSP) is generally used when another entity is responsible for paying before Medicare. The MSP regulations were put in place to protect Medicare Trust Funds by preventing Medicare funds from being used to pay for items and services that other health insurers are primarily responsible for paying. Primary payers essentially have the…Read More
CMS’s Plan Benefit Package (PBP) Software—Technical Redesign Coming to HPMS
CMS is modernizing its Plan Benefit Package (PBP) bid submission module for Contract Year (CY) 2024 Going live on April 7, 2023—the new web-based Plan Benefit Package (PBP) Software Technical Redesign will live within the Health Plan Management System (HPMS) and include updates to the user interface and data entry workflow. In previous years, users…Read More
How to Promote a Strong Compliance Culture—That’s Effective!
An organization’s commitment to compliance, or its compliance culture, is an important component of its overall organizational culture. Organizational culture is defined in The Cambridge Dictionary as the types of attitudes and agreed ways of working shared by the employees of a company or organization. A strong compliance culture is an organization-wide commitment to adhere…Read More
CMS Proposed Rule — CY 2024 Policy and Technical Changes
CMS Proposed Rule- On December 14, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the Proposed Rule for Calendar Year 2024 Policy and Technical Changes that includes revisions to regulations governing Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the…Read More
Model of Care (MOC) Development — What You Need to Know
Model of Care (MOC) approvals expiring December 31, 2022, must submit a new MOC by February 2023. CODY® can help you gain a 2- or 3-year approval on your Dual-Eligible SNPs (D-SNP) or Institutional SNPs (I-SNP) Model of Care (MOC). For Chronic SNPs (C-SNP), we can provide a review of requirements prior to the annual…Read More
Open Enrollment Period (OEP)—How to Retain Members
You have worked hard to gain and retain members—don’t let the Medicare Advantage Open Enrollment Period (MA OEP) be a time to lose them! The MA OEP runs from January 1 – March 31. During the MA OEP, Medicare Advantage plan members may switch to another MA plan or disenroll from their MA plan, return…Read More
CY 2023 CMS Readiness Checklist – Why is this Exercise Important?
Every October, the Centers for Medicare & Medicaid Services (CMS) distributes a Readiness Checklist to Medicare Advantage and Prescription Drug Plan (MAPD) Sponsors as a reminder to prepare for the upcoming plan year. Although CMS no longer requires Sponsors to submit assessment attestations, CMS still expects Sponsors to review the comprehensive checklist and self-assess their…Read More