Topic: Compliance

CMS Largely Holds Firm on Most Proposed MA Payment & Policy Changes for 2017

Olga Walther

On April 4th, the Centers for Medicare & Medicaid Services (CMS) issued the Final Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies, and 2017 Call Letter. This is the final notice of changes in rates of payment and overall policy.

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To Everything There Is a Season: Marketing Materials

Regan Pennypacker

There is a season for every activity within your organization: one for bids, one for applications, one for data validation.  We are soon to come upon marketing material season, when a flurry of activity usually gets underway in Marketing Communications and Compliance Departments nationwide.  Here are three reasons to ramp up: Read more

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Is the Honeymoon Over? Issuers Begin Receiving Direct Payment from the FFM System of Record

Diane Fischer

Although the financial hit may have been delayed a few months, it is still inevitable. Issuers will be moving from the driver’s seat when it comes to being paid for their members within the Federally-Facilitated Marketplace (FFM). Beginning in April 2016, FFM Issuers will feel the financial impact of being out of synch with the Marketplace for the first time.

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Four Easy Ways to Lose Revenue

Julie Billman

Times are busy. We are all doing more with less these days. Sometimes we don’t put processes in place to make sure functions continue when our focus is elsewhere.  Here are four easy ways you could be losing revenue: Read more

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MA Plans’ Must-Fix: the Member Experience

John Gorman

Now more than ever, it’s clear to us health plans and their stakeholders will thrive or die based on the member experience they provide. The member experience, especially with drug benefits, now represents more than half of a health plan’s Star Rating in Medicare Advantage (MA), with millions in bonuses and bid rebates hanging in the balance.  It also drives member retention and thereby acquisition expense (now averaging $1,200 per/member, or more than an average month’s premium), so how members are treated now determines both health plan revenues and costs. Read more

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Another Health Plan Cuts Commissions – Is there a trend developing?

Carrie Barker-Settles

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CMS’ Recent Enforcement Actions Show Agency Means Business in 2017

Olga Walther

As we predicted, the Centers for Medicare & Medicaid Services (CMS) is off to an aggressive start on the compliance front in the last year of this administration and shows no signs of slowing down with $832,250 worth of fines levied in the month of February alone. The list of enforcement actions released comes with even graver announcements of two immediate suspensions of enrollment and marketing for the year. These fines augment two huge penalties with which CMS closed out last year − $3.1 million and $1.3 million.

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