The Bridge – Volume 4

Weathering the Pandemic: Solutions for Staff Shortages

We acknowledge that the COVID-19 pandemic is occupying everyone’s attention and time.

We hope you are well and safe.

We recognize that life is radically different for most of us—both personally and at work—than it was just a few weeks ago.

Our company has made changes as needed and required to keep our employees safe and healthy — and we are here for you, too.

If you are experiencing reductions in staff, our turnkey solutions can help keep your back-office Medicare Operations up and running, fully compliant, and up-to-date. Our skilled BPO team can be onboarded in usually a week or less, and all have alternative work-from-home technology solutions in place and ready to securely support your operation.

Madena is currently able to offer any/all of our endto-end services, regardless of how large or small your company’s needs. As the pandemic evolves, we will augment
processes as necessary to continue to meet client deliverables while keeping staff safe.

Please reach out if you need help! Call: 720.428.2650 or Contact Us here

Madena’s COVID-19 Response & Readiness

Like all of you, we have had to become nimble as regards to changing work environments and state and federal regulations. Here’s a snapshot of our COVID-19 pandemic response and readiness.

  • We implemented a Pandemic Influenza Continuity of Operations Annex to our Continuity of Operation Plan (COOP), covering COVID19.
  • To enable all our staff to work remotely, we put in place a Work from Home Technology & HIPAA Security Assessment program in accordance with our Security & Privacy policies.
  • We have an internal, dedicated response team to monitor state and federal orders and changing regulations as regards to COVID-19.

We will continue to adapt our operations and policies as needed to prioritize the safety of our staff and surrounding communities.

As of this newsletter, Madena is fully operational and able to offer our entire suite of BPO, Consulting, and Data Analytics services, as well as our SAAS product, Membership Suite.

If you have concerns or questions, please reach out to our Pandemic Response Team at 202.744.4906 or

CMS has announced several changes in their audit and monitoring schedule for 2020.

It’s important to understand how key dates are shifting and what may impact your internal workplans and resource planning. Hopefully you have already mapped out your reporting, audit, and monitoring activities for 2020 and can easily push dates to later in the year. Our recommendation is to move the dates forward 2-3 months and look holistically at your 2020 resource needs. Be prepared to shift up tasks, or even do as much prep work as possible. Look
at opportunities for ‘dry runs’ on your data export activities that include pulling, scrubbing, and validating your data sets to be more prepared and efficient when the new dates are announced.

Need help with planning or executing a new schedule? We have data analytic and compliance resources available to support your organization in the face of change.

Here are the key CMS updates to take back to your teams for discussions and planning:

CMS has delayed the start of the Data Validation (DV) of the 2019 Part C and Part D Reporting Requirements data that was scheduled to begin on Wednesday, April 1, 2020. The 2020 Data Validation web-based training is not yet available on the Medicare Learning Network Learning Management System for data validation reviewers to complete.

CMS is reprioritizing its scheduled Program Audits for Medicare Advantage organizations, Part D sponsors, MedicareMedicaid Plans, and PACE organizations until further notice. CMS will continue its oversight of these organizations, but will temporarily shift their oversight activities from conducting routine audit activities to prioritizing the investigation and resolution of:

  • Instances of noncompliance where the health and/or safety of beneficiaries are at serious risk (for example, lack of access to critically needed health services or prescription drugs)
  • Complaints alleging infection control concerns, including COVID-19 or other respiratory illnesses.

CMS is suspending RADV activities related to the payment year 2015 audit and will not initiate any additional contractlevel audits until after the public health emergency has ended. Organizations should immediately suspend soliciting RADV-related medical records from providers. CMS will continue reviewing medical records that have been submitted, including submissions for the 2014 audit, and providing feedback to organizations though CDAT.

CMS will make an announcement when normal audit activities are resumed after the public health emergency has ended.

The requirement for Medicare health plans to submit HEDIS 2020 data covering the 2019 measurement year and the requirement to submit 2020 CAHPS survey data has been eliminated.

The elimination of these requirements for the same reporting years applies to Medicare-Medicaid Plans (MMPs) participating in demonstrations as part of the Financial Alignment Initiative.

CMS is moving the Health Outcomes Survey (HOS) administration to late summer and will provide more information to Medicare health plans in the coming months.

CMS has extended the deadline for Medicare-Medicaid Plans (MMPs) to begin using their revised state-specific IDNs no later than May 15, 2020. MMPs are also reminded that, prior to use, they must submit the IDN in HPMS for review and approval using the appropriate state-specific marketing code.

CMS said it will now use last year’s HEDIS measures scores and ratings from the 2020 Star ratings (based on care delivered in 2018) and CAHPS measures data scores and ratings from the 2020 measure-level Star ratings for 2021 Star ratings.

For 2022 Star ratings, CMS expects Medicare Advantage contracts to submit HEDIS data in June 2021, and Medicare Advantage and Prescription Drug Plan contracts to administer the CAHPS survey in 2021 as usual, so there is not a concern about data collection for the 2020 performance period.

View/Download a PDF of the April 2020 newsletter.