Topic: Brain Food

The Good, the Bad, and the Ugly!

Diane Hollie

Regarding the New Proposed Medicare Marketing Guidelines (MMG)

 

Taking a quick read of the proposed 2017 MMG, our marketing team had some initial thoughts about the proposed changes we would like to share.

Read more

Leave a comment | Share | |

This Is the Year to Get It Right

Regan Pennypacker

Five consecutive years of very similar audit protocol, continuous partnering with sponsors to identify improvements, and numerous best practice/common conditions memos. Where are you in audit readiness? Did you evaluate the items in the 2016 Readiness Checklist sent in November?  I will get back to that! In the meantime, the Centers for Medicare & Medicaid Services (CMS) has started sending audit letters, so we are aware of sponsors and Pharmacy Benefit Managers (PBMs) alike who are prioritizing CMS’ requests. Early bird catches the worm, am I right?  Presumably these plans have larger enrollment, since they will only be required to provide rejected claims for the one month of January.

Read more

Leave a comment | Share | |

Star Ratings Update: MedPAC Votes to Eliminate Double Bonuses

Melissa Smith

Star Ratings is already a hot topic in 2016, and we’re only one month into the new year.  In most recent news, the Medicare Payment Advisory Commission (MedPAC) unanimously voted last month to eliminate the double bonuses associated with Star Ratings, while also virtually unanimously voting to exclude diagnoses collected during in-home assessments from the Medicare Advantage Risk Adjustment model. Although the Centers for Medicare & Medicaid Services (CMS) may opt to take an alternate approach to resolve Risk Adjustment issues within Medicare Advantage, and since CMS can’t independently remove double bonuses with amending certain elements of the ACA legislation, this new development is a great reminder of the need to periodically pause and evaluate the value and ROI of programs which remain prominently placed on CMS’ radar screen.

Read more

Leave a comment | Share | |

Breaking the Incompatibility Barrier – Four Keys to Merging Operational Productivity and Compliance

Julie Billman

Can compliance and efficiency co-exist in Operations?  Is there a “right” balance between the two, or could it be more of an intertwining of the two?  If you have been in Operations long enough, you have been told you have to increase efficiency, reduce staff, and improve handle time or auto-adjudication rates.  What you probably have not been told is to be more compliant, except maybe by the Compliance Department.  Widgets in, widgets out, is the name of the game.

Read more

Leave a comment | Share | |

Risk Adjustment: Proposed Changes & New Regulations

Daniel Weinrieb

At Gorman Health Group (GHG), we pride ourselves on having our fingers on the pulse of what continues to be a complex and volatile government programs environment. Whether it is fact or fiction, our clients and our peers look to us to interpret and filter through the official announcements, the breaking news, the propaganda, and the hype.

Read more

Leave a comment | Share | |

Sales 2017 Readiness – Are You Maximizing Your Sales Potential Today?

Carrie Barker-Settles

Here we go again, planning for the upcoming selling season.  Every year it seems to approach more quickly than the year before.  Are you ready?  If the answer is no, or you are not sure, here are a few critical items to consider as you create your 2017 Annual Election Period (AEP) strategy: Read more

1 Comment | Share | |

Network Adequacy Top of Mind for CMS

Elena Martin

The Centers for Medicare & Medicaid Services (CMS) continues to reinforce its focus on health plan provider networks with several recent announcements.

Read more

Leave a comment | Share | |