Posts Tagged ‘Part C’
Proposed Change to CMS CY2024 Part C Reporting Requirements – NEW Category Added
CMS Regulatory Change: CMS is proposing an additional Part C reporting requirement for supplement benefits. This is scheduled to be an annual reporting requirement, due the last Monday in February of the following calendar year. Published in the Federal Register Vol. 88, No. 184 on September 25, 2023 and also on the CMS web site,…
Read MoreMedicare Secondary Payer (MSP) Processing—What’s Your Revenue Recovery Potential?
Medicare Secondary Payer (MSP) is generally used when another entity is responsible for paying before Medicare. The MSP regulations were put in place to protect Medicare Trust Funds by preventing Medicare funds from being used to pay for items and services that other health insurers are primarily responsible for paying. Primary payers essentially have the…
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 MoreOpen Enrollment Period (OEP)—How to Retain Members
You have worked hard to gain and retain members—don’t let the Medicare Advantage Open Enrollment Period (MA OEP) be a time to lose them! The MA OEP runs from January 1 – March 31. During the MA OEP, Medicare Advantage plan members may switch to another MA plan or disenroll from their MA plan, return…
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 Program Audit Findings & Key Preparation Tips
CMS released the 2021 Part C and Part D Program Audit and Enforcement Report on June 7, 2022. Highlights of the report indicate the average audit scores increased over the last report, stating 2020 average overall audit score of 0.15 to 2021 average overall audit score of 0.44. It’s worth noting, there were 27 plans…
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