2024 Oversight Activities – Utilization Management Changes

CMS notified Medicare Advantage Organizations (MAOs) on October 24, 2023, that it will be conducting strategic conversations on the new Utilization Management (UM) requirements effective January 1, 2024. Following these conversations, CMS will start conducting routine and focused audits of the new prior authorization and related rules published in April of this year in the…

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Surviving the 2015 AEP Materials Creation Process – Part 1 of 2

The Centers for Medicare & Medicaid Services (CMS) recently released its model documents for the 2015 Annual Enrollment Period (AEP). The rigorous, highly complex rules and regulations for member marketing materials wreak havoc on health plans year after year – and the clock is now ticking. Medicare plans must create, print and deliver AEP materials,…

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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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