Topic: Compliance

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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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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2016 CMS Application Season Begins

Regan Pennypacker

Yesterday CMS released the 2016 Part D application, and this afternoon the 2016 Medicare Advantage (MA) application was released.  Despite the applications’ release dates, potential and current Plan Sponsors should be well under way in the preparation of the upload that is due on February 18th.  Aspects of the application that require significant lead time to accomplish include the establishment of an adequate network and the acquisition of the required state licensure.

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ICD-10 Transition – Ready or Not?

Mae Regalado

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Annual Compliance Program Audit: Your Organization’s Achilles Heel?

Betsy Seals

When it comes to auditing throughout the Organization, the truth is that much of the responsibility often falls directly on the Compliance Department. This can be due to many factors, such as lack of resources or lack of cross-functional expertise. However, one of the CMS Compliance Program requirements is that the Compliance Program itself is audited annually. Fulfilling the requirement to annually audit the Compliance Program can present an issue for some Organizations due to the fact that Compliance Department self-auditing does not fulfill the requirement, and there may be no other department within the Organization with the expertise to conduct the review.

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Rewards and Incentives: Are We There Yet?

Betsy Seals

Yes, Medicare Advantage is finally catching up to the rest of the health care industry, and we are now permitted to offer enrollees Rewards and Incentives.

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