Posts Tagged ‘MA’
CMS CY 2024 Advanced Notice — The Inflation Reduction Act Requirements on Member Communications
Comments are due by March 3, 2023. The final notice will be released by April 3, 2023. The Inflation Reduction Act (IRA) of 2022 provides many provisions to reduce prescription drug costs for Medicare beneficiaries and Medicare Advantage (MA) members. The CMS CY 2024 Advance Notice included updates related to the IRA that should be…
Read MoreHow to Promote a Strong Compliance Culture—That’s Effective!
An organization’s commitment to compliance, or its compliance culture, is an important component of its overall organizational culture. Organizational culture is defined in The Cambridge Dictionary as the types of attitudes and agreed ways of working shared by the employees of a company or organization. A strong compliance culture is an organization-wide commitment to adhere…
Read MoreCMS 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 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,…
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