Coming Soon – CY23 Model Materials

In May, CMS expects to release the Contract Year (CY) 2023 model materials. These will be posted on the CMS site, CMS Marketing Models, and will include: Annual Notice of Change (ANOC) Evidence of Coverage (EOC) ANOC and EOC standardized model instructions Provider Directory Also expected to be released in May are the CY23 Part…

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Why 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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2023 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…

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AEP Enrollment Processing Tips—Do’s & Don’ts from End-to-End (E2E)

How well your organization handles a new enrollment during the Annual Enrollment Period (AEP) generally sets the tone for the upcoming contract year for you and your new member. Beginning with Sales and flowing to Enrollment Operations—it’s critical to understand specific actions that trigger reconciliation challenges and member abrasion. With CMS shifting the weight of…

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An Advance Look at Medicare Advantage Benefits Changes for CY2022

Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Plan Benefit Package (PBP) Software that Medicare Advantage (MA) and Part D plans use as part of their bid submissions. The PBP Beta Software is released in late January to allow plans to test and provide feedback before the full version is available…

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Independent Validation Audits

What’s Possible After a Program Audit? by Sue Dahlkamp, Interim Compliance Officer & Senior Consultant CMS requires that sponsoring organizations undergo an Independent Validation Audit (IVA) if they receive a number of ICARs or CARs on their Program Audit to demonstrate correction of all reported audit conditions. CMS then determines when the audit can be…

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