Topic: Brain Food

CMS Releases Part D Drugs and Formulary Requirements

Debra Devereaux

The long awaited revision to the Prescription Drug Benefit Manual Chapter 6 is hot off the press. Many of the changes have been published previously by CMS in Best Practice guidance or communicated in the course of CMS compliance audits. The changes include additions to the sections on Medically Accepted Indications, drugs purchased in another country, drugs covered under Medicare Part A or B, policy regarding formulary changes, updates to the description of covered commercially available combination products, and updates to existing policies with respect to utilization management

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Countdown to Final Submit

Regan Pennypacker

Today is the final day for current or potential plan sponsors to submit their Medicare Advantage and/or Part D application for a new contract or service area expansion (or service area expansion  for 1876 Cost Plans). By now, many of you have already hit final submit and are either celebrating or working on known deficiencies. Or, perhaps you are still waiting for documentation or a final quality check of your submission before you feel confident to submit. Here are a few of the things we learned this year along the way. Read more

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In 2015 a Slap on the Wrist Can Be the Kiss of Death

John Gorman

It is truth that in the second term of Democratic administrations, scores get settled between Washington regulators and business partners of the Federal government.  2015 will be no different for our favorite agency, the Centers for Medicare & Medicaid Services (CMS).  It’s already on a pace for 2015 to be the toughest year ever in enforcement actions against Medicare Advantage plans.  And generally speaking, the regulatory bar is rising faster than anyone imagined.  Consider: Read more

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Medicare Secondary Payer (MSP) is all about the money.

Christine Tobin

Money going out as a result of paying claims as primary payer when it’s possible you should be paying as secondary payer. CMS reduces plan payments for members with MSP, shown on the Monthly Membership Report (MMR) as an MSP adjustment (reduction).

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2016 CMS Applications: Highlights and Basics

Regan Pennypacker

This week’s CMS industry training on applications was quite informative, and contained many audience questions that you will want to hear.   The recording is already available to registrants for those who missed it.  There was way too much information for me to summarize, so I have included here a few highlights from the call and some basics that are easily overlooked.

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How to Maintain the Accuracy & Consistency of Data through an Entire Life Cycle

Christine Tobin

It doesn’t matter whether you call it the Annual Election Period (AEP), Open Enrollment Period or Fall Open Enrollment; it’s that busy time of the year when beneficiaries are on the move. Now that the dust has settled, it’s time to take a thorough look at your member data. Your members are your revenue. Accurate member data and continuous maintenance will yield the maximum, most accurate level of revenue to your organization.

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Operational Assessment – time for a “Check-Up”

Christine Tobin

It’s time for an operational assessment.

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