Posts Tagged ‘Medicaid’
Risk Management for Health Plans – Part 3
In Part 2 of our Risk Management for Health Plans series, we provided a high-level understanding of how to approach risk management from a tactical perspective. This week we will provide you with a strategic framework to apply to your program. The 5 Pillars of Risk Management Keep in mind, Risk Management is a continuous…
Read MoreRisk Management for Health Plans – Part 2
In Part 1 of our Risk Management for Health Plans series, we focused on risk culture. This week we will get more tactical and breakdown the operational approach to risk management. Organizational Approach to Identifying & Managing Risk The day-to-day operational approach to risk management requires people, processes, and systems for any organization to properly…
Read MoreRisk Management for Health Plans – Part 1
Recently, CODY® conducted, through our partnership with the Association for Community Affiliated Plans (ACAP), a webinar titled Identifying & Managing Risk. These are a few of the questions regarding risk management for health plans that we considered: How effective is your organization at identifying and managing risk within your health plan from an operational and…
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 MoreCodySoft® Allied Central Dashboard™ (ACD) FAQs
Creating, managing, and tracking recurring orders for mandated member materials fulfillment can be complex and time-consuming. Not to mention, file and data validation, SLA management, and tracking errors, issues, and processing audits—adds even more to manage. To ease the burden, that’s where the CodySoft® Allied Central Dashboard™ (ACD) comes in. By leveraging automation, the ACD…
Read MorePERSPECTIVES: Combining Medicare and Medicaid into One Program
The status quo of government-sponsored health programs is beginning to fail. The government recently reported that Medicare will run out of money in less than 20 years unless drastic changes are made. But how can our health care system be altered to correct deficiencies and adjust to changing conditions, avoid a huge financial crisis in…
Read More6 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…
Read More3 Ways your Health Plan is Overspending – And How to Stop
Health plans today are feeling more pressure than ever before to do more with less. With increased scrutiny from The Centers for Medicare and Medicaid Services (CMS) and decreased budgets, leadership is constantly looking for ways to save money. Doing so might be easier than you think. Below are three ways that health plans are…
Read MoreBest Practices for Reporting on Plan Oversight of Agents
For Medicare Advantage Organizations (MAOs), Part D Plans and Cost Plans, reporting on “Plan Oversight of Agents” can be a labor-intensive and time-consuming process that presents a number of challenges along the way.
Read More3 Challenges to Reporting on Plan Oversight of Agents
Each year, Medicare Advantage Organizations (MAOs), Part D Plans and Cost Plans are required to submit data on their Part C and D plans to The Centers for Medicare and Medicaid Services (CMS) for the previous calendar year.
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