Posts Tagged ‘CMS’
CMS Reposts CY2023 ANOC & EOC Models
On August 1, CMS reposted the revised Contract Year (CY) 2023 Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) models due to several identified issues. CMS distributed its “Model Notice Corrections” memo the following day, highlighting many of the changes. This is the first time since 2018 that CMS has provided revised models…
Read MoreRevised CMS CY23 ANOC & EOC Models — Expected Soon!
Keep an eye out for an upcoming CMS memo regarding the reposting of the CY23 ANOC & EOC models. Per CMS, the documents revealed several issues. Rather than sending a “very detailed” and lengthy corrections memo, CMS’s memo will coincide with the reposting of the models and include a summary of changes. The revised models…
Read MoreCMS Program Audit Findings & Key Preparation Tips
CMS released the 2021 Part C and Part D Program Audit and Enforcement Report on June 7, 2022. Highlights of the report indicate the average audit scores increased over the last report, stating 2020 average overall audit score of 0.15 to 2021 average overall audit score of 0.44. It’s worth noting, there were 27 plans…
Read MoreThe Medicare Timeliness Monitoring Project (TMP)—What to Expect?
CMS continues to conduct an industry-wide Timeliness Monitoring Project (TMP). This project is a retrospective review of 2022 data. It allows CMS to collect data to evaluate the timeliness of processing Medicare Part C reconsiderations, using the new TMP and audit protocols in place for 2022. As a reminder, this data is used to verify…
Read MoreCMS Model Materials—Significant Changes for CY23
Wow! The CMS model materials were released weeks earlier than previous years, and we’re thankful for that! There are significant changes for CY23: most notably the reduction in length, reorganization, and reduction of tables and language. View the CY23 Models here: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/MarketngModelsStandardDocumentsandEducationalMaterial CMS Model Materials Notable Changes Annual Notice of Change (ANOC)—Notable Changes (applies to…
Read MoreNew CMS Guidelines for Individuals Not Lawfully Present—Are Your Systems Ready?
Ensuring Member enrollment records are accurate is no easy task. The Centers for Medicare and Medicaid Services (CMS) makes policy changes regularly, and it is up to the individual Health Plans to keep up. Last November, CMS announced in an HPMS memo they would make updates to their policy for Individuals Not Lawfully Present. Effective…
Read MoreHow to Ensure a Successful Triennial Network Adequacy Review
CMS monitors compliance with Network Adequacy Standards on a triennial basis. Every three years CMS requires a plan to upload its full-contract-level network into the Network Management Module (NMM) in Health Plan Management System (HPMS). When selecting contracts for the triennial review period, CMS pulls from the list of active contracts—primarily based on when the…
Read MoreComing Soon – CY23 Model Materials
In May, CMS expects to release the Contract Year (CY) 2023 model materials. These will be posted on the CMS site, CMS Marketing Models, and will include: Annual Notice of Change (ANOC) Evidence of Coverage (EOC) ANOC and EOC standardized model instructions Provider Directory Also expected to be released in May are the CY23 Part…
Read MoreWhy Consolidating COB & MSP Data Collections Are Crucial for Health Plan Revenue Recovery & Compliance
The Centers for Medicare and Medicaid Services (CMS) requires MA and PDP health plans to update systems timely and accurately. Consolidating and analyzing COB & MSP data collections while maximizing recovery options and complying with CMS regulations is a challenging task. Incorrect data sets can easily contribute to non-compliance and lead to inaccurate claims payments,…
Read MoreMedicare Communications & Marketing Guidelines (MCMG)—CMS Updates Warrant a Thorough Review
Last month, CMS published a new MCMG, and it looks quite different! Not only is it much shorter, 51 pages compared to the previous 84 pages, it now has CFR references for all sections. Upon review, CMS has removed several details, seemingly anything without a CFR reference which accounts for the slimmed-down version, and it…
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