Topic: Compliance

Medical Loss Ratio Concern in CMS Proposed Medicaid Rule

Sunmi Janicek

The much anticipated Medicaid regulation from the Centers for Medicare & Medicaid Services (CMS) has been released, which aims at helping align regulations for managed care plans, creating a dynamic shift in how the Medicaid business will be handled moving forward.

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CMS 2015 Spring Conference

Regan Pennypacker

Some important points came out of the Centers for Medicare & Medicaid Services’ (CMS’) Medicare Advantage Prescription Drug (MA-PD) Spring Conference & Webcast; the presentations and videos of the event can be found here in CMS’ Event Archives.  If you did not have a chance to attend or watch it live, please watch the videos for important changes pertaining to many aspects of the MA-PD program.  Speakers addressed Part C and Part D call letter updates, policy and technical changes, Quality Improvement Project (QIP) and Chronic Care Improvement Program (CCIP) lessons learned and best practices, the new network management module, enrollment updates, and fraud, waste, and abuse (FWA).

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The Imminent Medicaid Mega-Reg is Gonna be “Epic”

John Gorman

For the last several weeks health policy nerds have been anxiously awaiting the release of the long-awaited Medicaid managed care proposed rule, the first from the Centers for Medicare and Medicaid Services (CMS) in 13 years. We’re coming to call it the “mega-reg” here.  Friday at the Congressional advisory MACPAC meeting, Commissioners were widely quoting  the term “epic” used by Jeff Myers, CEO of Medicaid Health Plans of America, in a recent National Journal article.

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Five Critical Steps to Enhance Revenue & Maximize Growth Potential

Glenn Ellerbe

Everybody’s talking about revenue management and maximizing growth opportunities for health plans, but no one has laid out the steps for successful outcomes…until now.  Gorman Health Group (GHG) is giving you our recipe for enhancing your premium revenue and maximizing your growth potential in the following five-step plan:

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19 Lessons from 19 Years

John Gorman

Nineteen years ago this week, I left the Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS) and the Office of Managed Care, to launch what would become Gorman Health Group.  Time has flown, the company has grown, and my backside sewn with hard lessons about our industry and government health programs.  Here are 19 lessons I’ve learned in those 19 years. Read more

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Spring Fever Focus: Grievances and Appeals

Regan Pennypacker

Spring is here, showing us all different signs of renewal.  It motivates us to clean out clutter, open those windows, and start the year fresh.  Audit season is also upon us, and people are taking a close, hard look at internal processes that surround grievances and appeals processing.  Findings in this area keep showing up, like that college grad that keeps popping in to visit his friends back on campus.  Just leave already, you’ve had your time!

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Gorman Health Group Client Forum Takeaways: Government Programs are Booming, Bar is Rising

John Gorman

We just wrapped our best-ever Gorman Health Group 2015 Client Forum at National Harbor with over 200 of our closest clients and partners.  There was both great and tough news, so here’s a few takeaways, including a couple stunners: Read more

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