Topic: Brain Food

The Impact of CMS Changes on MA & FFM 2016 Agent Readiness

April Fleming

Preparing for the 2016 selling season means implementing a strategy that mitigates compliance risks for your organization and empowers your sales force to meet your enrollment targets. In our recent webinar regarding the impact of the Centers for Medicare & Medicaid Services (CMS) changes on Medicare Advantage (MA) and Federally-Facilitated Marketplace (FFM) 2016 Agent Readiness, I outlined key takeaways your organization needs to enforce in order to protect your health plan from compliance risks while also positioning it for sales success in 2016 and beyond.

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The Affordability Review – “Reading the Tea Leaves”

Nancy Djordjevic

The fall season is a good reality check – back to school, cooler weather, end of summer, and …. Budgeting/financial forecasting. Forecasting is like predicting the future – you have to know how to read the tea leaves and see the efficiencies and interdependencies of your current performance to have a better idea of future performance and challenges.

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Medicare at 50: Past, Present & Future

Jean LeMasurier

Since its inception on July 30,1965, millions of elderly and disabled Americans have been able to obtain medical care through Medicare. Before Medicare, almost half of all Americans 65 and older had no health insurance. Today that number has dropped to a staggering 2 percent.

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MLTSS: Key to Caring for Duals

Mayling Naputi

We all want to do it: Provide the best healthcare services for our members. For our vulnerable population, this can be complicated, if not near impossible to achieve, given the current healthcare issues at hand.

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EHR Incentive Programs: Improving Access to Care

Mayling Naputi

The 2014 Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were developed to provide financial incentives to eligible professionals, eligible hospitals, and Critical Access Hospitals (CAHs) to achieve meaningful use of certified EHR technology with the goal of improving patient care.  The programs worked to prompt healthcare providers to adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.  In her May 18, 2015, article in RevCycleIntelligence, Jacqueline DiChiara reported by the end of 2014, EHR incentive payments reached over $28 billion with eligible hospitals receiving more than $17 billion, Medicare and Medicaid-eligible professionals collectively receiving nearly $10 billion.  However, there are some changes with the EHR Technology Incentive Program that may affect your revenue—and not in a good way.

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At the Intersection of Exhausted and Impossible

Debra Devereaux

Today, most employees and employers in all organizations struggle to do more with less…not just health plans.

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Quality Ratings: No National Standard for MCOs…Yet

Sunmi Janicek

A recent article noted five major changes in new Medicaid Managed Care rules, one pertaining to a quality ratings system. Many states have quality ratings for managed care plans, but currently there is no national standard.  Medicare has a five-star system evaluating private plans, and private plans offered through the Affordable Care Act’s (ACA’s) Health Insurance Marketplace will begin publishing quality ratings in 2016.  Ratings for Medicaid managed care plans would look similar to the Marketplace plan ratings.

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