Posts Tagged ‘compliance’

Can Outsourcing Your Member Marketing Materials Production Pay for Itself?

Many health plans are currently considering how to manage creation and distribution of marketing materials due to members September 30. The reality is, health plans have two options: Develop materials in-house, and outsource printing and fulfillment to a vendor; or Outsource the entire materials production process – materials creation, and print and fulfillment – to…

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6 Traits of a Great Consulting Partner

In the world of Medicare and Medicaid, choosing a consulting partner to help streamline your health plan’s operations can be tricky. While a company or individual may be well-versed in best practices for project management or operational efficiency, they may not understand the unique requirements of the payer market – making them less than effective…

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Errors 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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3 Ways Growing Health Plans can Avoid Adding FTEs

Health plans today are feeling more pressure than ever before to do more with less. This is especially true now that health plans have to operate within the federal minimum medical-loss ratio (MLR) requirement. The minimum MLR requirements leaves health plans with only 15 percent of their Medical revenue to spend on administration, marketing, and,…

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4 Ways to Prepare for Increased CMS Oversight in the wake of Secret Shopper Success

Good news for Medicare agents and brokers: The Centers for Medicare and Medicaid Services (CMS) recently reported that of the 1,320 marketing events secretly shopped during the 2014 contract year Annual Enrollment Period (AEP), 85.5% were fully compliant. This is a huge improvement from previous years, when CMS found more than half of secretly shopped…

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Are you prepared for a CMS audit?

If The Centers for Medicare and Medicaid Services (CMS) walked through your door today and asked to audit your health plan, would you be prepared? Unfortunately, for many Medicare Advantage and prescription drug plans, the answer is “no.” Yet, with CMS continuing to crack down on compliance violations, this hypothetical audit could very well become…

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Using Technology to Streamline Your Policies and Procedures

Policies and procedures are an important part of health plans’ day-to-day operations. However, if these are not documented and managed properly – including being updated each year – health plans may be subject to costly fines and corrective action plans from the state.

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Choosing the Best IT Solution to Manage AEP Collateral Creation

A number of IT solutions have emerged over the last several years to help health plan marketing and compliance teams manage the materials creation process. These solutions range from costly enterprise installs to more affordable cloud-based applications, and offer any number of features to help plans navigate the AEP collateral creation season.

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How 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…

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