Posts Tagged ‘CMS’
Are Your Policies and Procedures Audit-Ready?
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,…
Read MoreHow to be a Rising Star—What Ratings Mean and How to Improve Them
It’s no secret that Star Ratings can have a significant impact on a health plan’s membership and bottom line. As competition increases, it’s essential to have strategies in place to elevate or maintain a 4+ star rating. The Centers for Medicare and Medicaid Services (CMS) recently released Highlights of Contract Performance in 2021 Star Ratings.…
Read MoreCODY CEO authors chapter in new book for healthcare compliance professionals
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…
Read MoreCMS Skips Another Year on the MCMG
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…
Read More4 ways to reduce – or eliminate – errors in your ANOCs and EOCs
The accuracy of Annual Notice of Changes (ANOC) and Evidence of Coverage (EOC) documents is an important requirement for all health plans. The Centers for Medicare and Medicaid Services (CMS) takes errors in these documents very seriously and penalties are given to health plans that distribute documents with errors. CMS recently announced changes to the…
Read MorePERSPECTIVES: Combining Medicare and Medicaid into One Program
The status quo of government-sponsored health programs is beginning to fail. The government recently reported that Medicare will run out of money in less than 20 years unless drastic changes are made. But how can our health care system be altered to correct deficiencies and adjust to changing conditions, avoid a huge financial crisis in…
Read MoreDealing with Change in the Medicare World
The healthcare world and Medicare health coverage are in a state of rapid and uncertain change. What can health plans and those serving health plans, such as pharmacy benefit managers and even consultants, do to be ready for both anticipated and unanticipated changes? Here are some of the issues facing the industry in today’s turbulent…
Read More3 Ways your Health Plan is Overspending – And How to Stop
Health plans today are feeling more pressure than ever before to do more with less. With increased scrutiny from The Centers for Medicare and Medicaid Services (CMS) and decreased budgets, leadership is constantly looking for ways to save money. Doing so might be easier than you think. Below are three ways that health plans are…
Read MoreStart Now for an Easier ANOCs and EOCs Creation Season Next Year
Every year, the people who produce marketing materials for their Medicare members are extremely busy from April through September. Deadlines are tight and timelines are aggressive for creating, printing and mailing the Annual Notice of Changes (ANOCs), Evidence of Coverage (EOCs) and Summary of Benefits (SBs) documents. Very few people in these roles take vacation…
Read MoreErrors in ANOCs and EOCs could cost up to $55 per affected enrollee
Over the last several years, The Centers for Medicare and Medicaid Services (CMS) has taken an increasingly tough stance on health plans that distribute Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents with unclear and/or inaccurate benefit information. CMS is no longer sending health plans warnings for these errors; they are imposing…
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