Topic: Part D

They Still Don’t Like It

Debra Devereaux

In the October 8, 2014 memo entitled “Contract Year 2014 Part D Formulary Administration Analysis (FAA)”, CMS reiterates their concern with the accuracy of formulary coding. For the April 2013 analysis, 9 out of 88 (10.2 %) plan sponsors were found to have failed FAA, meaning that greater than 20% of the sampled rejects were determined to be inappropriate. The parameters for the 2014 FAA are: Read more

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The 2015 Ratings are In: Have the Stars Aligned?

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) has released the 2015 Medicare Advantage Star Ratings, and the Stars seem to be aligning with CMS’ goals of the Star Ratings program.  For the 40% of Medicare Advantage plans earning at least 4 Stars this year, and thus qualifying for Quality Bonus Payments, these newly-released Star Ratings illustrate the value of health plans’ investments in clinical innovation and quality improvement within Medicare Advantage product offerings.

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Part D Rejected Claims Continue to be Important Monitoring for CMS

Wayne Miller

Rejected claim analysis is a year-round activity with special emphasis that should begin before January. Are you confident in your current process to review and identify non-compliant rejected claims?

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It’s a Marathon – Not a Sprint

Debra Devereaux

Plans will shortly be receiving the Readiness Checklist from CMS. At first glance it looks like just a bunch of boxes to check off and answering yes and no questions. Here’s the rub:

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Another Flood of Good News for Medicare Advantage

John Gorman

Last week the Centers for Medicare and Medicaid Services (CMS) did its annual data dump for the 2015 Medicare Advantage (MA) and Prescription Drug Plan (PDP) bids.  Even with MA plans sailing into the worst rate environment in over 15 years, the data offered another flood of good news for the industry.

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Bombshells from MedPAC on Medicare Advantage Retention

John Gorman

The Medicare Payment Advisory Commission (MedPAC ), the nonpartisan blue-chip Congressional uber-nerds on our favorite entitlement program, met this week and the staff report presented a couple bombshells on retention rates in Medicare Advantage (MA).

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CMS’s Star Ratings Firing Squad Gets Squirt Guns

John Gorman

Last week, in a surprise move, the Centers for Medicare and Medicaid Services (CMS) reversed its threat to terminate all Medicare Advantage and Part D health plans with 3 or fewer Stars for more than 3 consecutive years.  Roughly a dozen health plans were lined up in front of the firing squad as an example to the industry for months — and then CMS issued squirt guns to the executioners. 

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