Topic: Brain Food

Outbound Enrollment Verification (OEV) – To call or not to call?

Betsy Seals

With the release of the 2015 Marketing Guidelines, CMS made a few key updates to the Outbound Enrollment Verification (OEV) Process. One of the most significant updates is that CMS now allows organizations to complete the OEV process via direct mail or email (if the beneficiary opted-in for email). This change actually provides significant opportunity for organizations. The way we see it, organizations will now need to choose one of two paths. The first path is to continue using outbound telephone calls to fulfill the CMS requirement. If your organization has developed and implemented an effective OEV process, by all means continue with this process. However, if you’re thinking “why would we continue the current process when our OEV process has been riddled with issues of non-compliance?” Well, we agree.

Read more

Leave a comment | Share | |

Rejected Claims Review–You Gotta Do It!

Debra Devereaux

The question arises from almost every client, “Why do we have to do daily rejected claims review?” The answer is that there is no better way “to take the temperature” of Part D compliance than rejected claim reviews. Everything that can and will occur happens at Point of Sale. At a minimum you can detect problems with the following:

Read more

Leave a comment | Share | |

It’s silly season again, so let’s sue the President

William MacBain

The Speaker of the United States House of Representatives, one of the most senior elected officials in the US government, has announced that the House is going to sue the President because he has delayed enforcement of a provision of the 2010 health care law; a provision that a majority of that same House has vociferously criticized as unfair to business and a “job killer.” In 2014 Washington, this makes perfect sense.

Read more

Leave a comment | Share | |

Tuesday Night’s Primary Elections Were Huge. Here’s What They Mean for Our Industry.

John Gorman

House Majority Leader, Eric Cantor (R-VA) is toast.  Trounced in his Richmond district by a nobody Tea Bagger Tuesday night. Cantor gave up his leadership position yesterday. Depending on where you sit politically, either the unthinkable or the inevitable happened.  In fact, a Majority Leader hasn’t lost incumbency since the office was created in 1899.   “The defeat of the second-ranking Republican in the House by an ill-funded, little-known tea party-backed candidate ranks as the biggest congressional upset in modern memory and will immediately generate a series of political and policy-related shock waves in Washington,” wrote Chris Cilizza of WaPo.

Read more

Leave a comment | Share | |

Follow the Leader: United Health Group’s Outlook on Government Health Programs

John Gorman

Ralph Giacobbe at Credit Suisse is a leading health industry analyst and is doing the best work of his career.  Today he produced a fantastic recap of his discussion with United Health Group CEO Steve Hemsley and several of his top executives.  It included some fascinating insights into the market leader’s strategy for government health programs:

Read more

Leave a comment | Share | |

Lighting the Path in the Golden Age of Government-Sponsored Health Programs: Join Us for the GHG Client Forum

John Gorman

More than 300 guests will convene on May 1-2 at the Red Rock Casino in Las Vegas for the 2014 Gorman Health Group Forum, our annual strategic retreat for leaders in government-sponsored health programs. This year’s gathering promises to be the most actionable, content-packed conference you could attend on how to succeed in this new Golden Age of government business. And when the learning and planning is done for the day, we will celebrate this unique moment in health care history as only GHG can in Vegas.  Here’s what’s happening this year and why you’ve got to join us: Read more

Leave a comment | Share | |

Innovation and Quality must go hand-in-hand

Regan Pennypacker

Plan sponsors are waiting with anticipation for their 2014 Medicare Star Ratings to be released. Just yesterday, Tufts Health Plan in Watertown, Massachusetts released the news that their Medicare Preferred HMO plan was awarded 4.5 out of a possible five stars. It reminds me of the old Ford commercial jingle where they said “Quality is Job 1″. No truer words apply when it comes to maintaining high quality plan options for our nation’s Medicare beneficiaries.

Read more

Leave a comment | Share | |