Posts Tagged ‘MA’
CMS Proposed Rule — CY 2024 Policy and Technical Changes
CMS Proposed Rule- On December 14, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the Proposed Rule for Calendar Year 2024 Policy and Technical Changes that includes revisions to regulations governing Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the…
Read MoreCMS End-of-Year (EOY) Low-Income-Subsidy (LIS) Activities—Is Your Health Plan Up to Date?
Hopefully, you are off to a successful AEP! To keep the momentum going, here’s some valuable information and best practices regarding EOY activities, including the Low-Income Subsidy (LIS)/Reassignment process. Is your staff well-versed in these activities? Are your systems ready to accept CMS’ year-end files? If not, read on to learn more! As referenced in…
Read MoreCY 2023 CMS Readiness Checklist – Why is this Exercise Important?
Every October, the Centers for Medicare & Medicaid Services (CMS) distributes a Readiness Checklist to Medicare Advantage and Prescription Drug Plan (MAPD) Sponsors as a reminder to prepare for the upcoming plan year. Although CMS no longer requires Sponsors to submit assessment attestations, CMS still expects Sponsors to review the comprehensive checklist and self-assess their…
Read MoreEnd-of-Year 2022 Enrollment and Payment Systems Processing—What You Need to Know
As the CMS Annual Rollover process quickly approaches, health plans must prepare to complete critical End-of-Year (EOY) tasks. Now’s the time to ask—Are your systems configured to process rollover files seamlessly? Does your staff know how to process transactions requiring manual intervention? Any mishaps during this process will create a negative member experience regarding access…
Read MoreAEP 2023—Essential Readiness Tips & the Latest CMS Guidance
Medicare Advantage Annual Enrollment Period (AEP) runs from October 15 to December 7. Since most health plans recognize growth this time of year, it is imperative to be prepared to enroll members seamlessly and accurately. Are your systems configured with the latest guidance from CMS? Has your staffing and training efforts increased to ensure work…
Read MoreCMS 2023 Final Notice & Updates for D-SNPs — What Should Plans Do Now?
In May, CMS published the 2023 Final Rule in the Federal Register. The rule includes many changes related to different areas, including marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions; however, there are a number of changes related to…
Read MoreCMS 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 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…
Read More2023 Star Rating Changes—CMS Advanced Notice for Review & Comment
CMS released the “Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies” on February 2, 2022, with feedback accepted until March 4, 2022. Some changes may impact Star Ratings for CY 2023. To submit comments or questions electronically, go to…
Read More