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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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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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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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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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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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…

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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…

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