How to Build an Effective Compliance Monitoring Program & Support Ongoing Risk

A monitoring program is an important part of a health plan’s compliance program and provides valuable information to the Compliance Department to ensure the plan is meeting requirements. Effective monitoring requires coordination with operational areas and supports ongoing risk assessment. Monitoring not only provides a mechanism to detect compliance issues throughout the organization but also…

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How Can a “Single-Source Solution” Help Manage the Lifecycle of Member Communications?

If you are tasked with the challenge of managing the lifecycle of Member Communications—you likely need an efficient “Single-Source Solution” to help. Managing multiple vendors for document development & creation (ANOCs, EOCs, SBs/SOBs/SBCs, Pre & Post Enrollment materials), translations, Section 508 remediation, directories & formularies, as well as the sourcing of member communications print &…

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The Bridge — Volume 12

Madena™ and CODY® Merge to Expand Technology and Consulting Capabilities CODY® Acquires Madena Madena has been acquired by CODY®, a leading healthcare technology and consulting firm. The combined offerings and decades of industry expertise provide Medicare, Medicaid, and Commercial health plans an ‘end-to-end integrated solution’ previously unavailable in the marketplace. CODY® works with over 60…

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An Advance Look at Medicare Advantage Benefits Changes for CY2022

Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Plan Benefit Package (PBP) Software that Medicare Advantage (MA) and Part D plans use as part of their bid submissions. The PBP Beta Software is released in late January to allow plans to test and provide feedback before the full version is available…

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How to Mitigate Compliance Risk & Improve Operations—An A-to-Z Approach

As the Centers for Medicare and Medicaid Services (CMS) increases its scrutiny and escalates enforcement, Compliance managers are on guard to ensure regulatory standards are met—and fines, sanctions, or even termination from CMS programs, are avoided. How can Compliance and Operations managers mitigate compliance risk and improve operations? The best way to avoid compliance errors…

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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,…

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How 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.…

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Six Reasons Why Consolidating Software Applications Makes Sense

In today’s rapidly changing environment, health plans operating in silos or with dated legacy systems are struggling to keep up. As competition increases and technology evolves, companies are searching for answers—should they purchase software applications individually or buy a suite or bundle? IT purchasing managers face difficult challenges as business needs grow, software solutions change,…

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Can Artificial Intelligence (AI) Change the Future of Healthcare Operations?

Artificial Intelligence (AI) will become a larger factor in all facets of life soon… …in everything from self-driving cars to industrial manufacturing to the way we entertain ourselves. These changes will impact every part of healthcare also, from diagnosis through treatment and even into administrative and operational functions. CMS has started two initiatives directly related…

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CMS 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…

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