For MA Plans: Increased Payments will mean Increased Compliance

By now, it is safe to assume that health plans across the nation have thoroughly read and examined CMS’ Final Medicare Advantage (MA) Rate Announcement and Call Letter for 2016. I think we all heard a collective sigh of relief with the announcement that reimbursements would increase, rather than decrease, in the coming year.

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Surviving the 2015 AEP Materials Creation Process – Part 2 of 2

Medicare plans are mid-way through the process of creating Annual Election Period (AEP) materials – namely, Annual Notification of Change (ANOC) and Evidence of Coverage (EOC) documents – that are due to members by the end of September. At this stage of the game, tension is running high. By now, many health plans have likely…

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How the ACA Will Create a More Portable Workforce

Health insurance, pensions, retirement plans and other employer-sponsored benefits were originally created during World War II as a way for companies to be more competitive in attracting and retaining employees. Countless factors over the decades have changed the shape of company benefits, but the Affordable Care Act (ACA) is going to dramatically change the dynamic…

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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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The Millions of Dollars in Savings You’re Not Seeing – PART 2 of 2

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 Millions of Dollars in Savings You’re Not Seeing – PART 1 of 2

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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