Posts Tagged ‘collateral project management’
2024 Oversight Activities – Utilization Management Changes
CMS notified Medicare Advantage Organizations (MAOs) on October 24, 2023, that it will be conducting strategic conversations on the new Utilization Management (UM) requirements effective January 1, 2024. Following these conversations, CMS will start conducting routine and focused audits of the new prior authorization and related rules published in April of this year in the…
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 MoreHow Medicaid Plans can Prepare Compliance Efforts for Increased CMS Oversight
The writing is on the wall. There are well-documented issues of a lack of uniformity and accountability surrounding state Medicaid programs. Understanding CMS’s history of recognizing problems and acting to find solutions, it stands to reason the agency will, in the future, establish compliance programs for state Medicaid plans that mirror those of Medicare. When…
Read MoreThe Millions of Dollars in Savings You’re Not Seeing – PART 2 of 2
The “cost to do business” doesn’t have to be so expensive for government-sponsored health plans. Most payers are overspending on their annual print and fulfillment budget for member communications by 10-15 percent. For plans with 250,000 members, for example, cutting a 15 percent overspend factors to saving $1.2 million a year. There are a number…
Read MoreThe Millions of Dollars in Savings You’re Not Seeing – PART 1 of 2
The “cost to do business” doesn’t have to be so expensive for government-sponsored health plans. Most payers are overspending on their annual print and fulfillment budget for member communications by 10-15 percent. For plans with 250,000 members, for example, cutting a 15 percent overspend factors to saving $1.2 million a year. There are a number…
Read More